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CQEHRIGHT DEPOSIT. 



PRACTICAL TALKS 

ON THE 

CARE OF CHILDREN 



PRACTICAL TALKS 

ON THE 

CARE OF CHILDREN 



BY 

MARY E. BAYLEY, R.N. 



WITH AN INTRODUCTION BY 

VIRGIL P. GIBNEY, M.D. 




NEW YORK 
E. P. DUTTON & COMPANY 

681 Fifth Avenue 



Copyright, 1922, 
BY E. P. DUTTON & COMPANY 



All rights reserved 






PBINTED IN THE T7NITED STATES OV AKEBIOA 

NOV 20 72 

©C1A680038 



To The Memory of 
E, L. H. 

the chief inspiration of this work 
This Book is Inscribed 
in loving appreciation 



JUST A WORD 

In preparing for book form these chapters which 
first appeared in The Delineator, The Designer and 
The Ladies Home Journal, the author has kept in mind 
and has endeavored to answer personal questions 
which have come to her from thousands of mothers 
throughout this country and Canada. One of these 
chapters alone after appearing in a magazine brought 
to the author's desk no less than eight hundred letters 
in a single month. The nature of these letters has led 
her to believe there is a definite need for a book describ- 
ing some of the safest and sanest teachings of physi- 
cians, nurses and teachers (who rank among the high- 
est authorities) in a manner so clear and concrete that 
the least experienced person may find them practical. 

For information, assistance and criticisms of the 
finished chapters, the writer is indebted to many 
physicians, who have given freely from their experi- 
ence and thought, among them being : — 

Doctors Charles Hendee Smith, Menas S. Gregory, 
Charles Dana, Charles Kerley, Virgil P. Gibney, John 
E. Weeks, Alan De Forest Smith, T. Stuart Hart, 
Edward H. Rogers, George Huston Bell, William H. 
Park, Abraham Zingher and Frederick H. Martin 
(Doctor of Oratory). It is with pleasure that I avail 

vii 



viii JUST A WORD 

myself of the opportunity to acknowledge the interest 
and assistance of these physicians. Particularly, do I 
wish to thank Doctor Charles Hendee Smith for his 
cheerfully given advice and assistance in preparing the 
chapter, "Diet Schedules and Food Formulas," and for 
his preparation in full of the chapter "How to Make 
a Formula." 

I am also under deep obligation to my friend, Mrs. 
William Brown Meloney, for her kindly encourage- 
ment and helpful suggestions. 

The frontispiece is the work of Mr. Emil Fuchs, the 
noted sculptor and artist. To Mr. Fuchs I extend 
my thanks and appreciation for his generous permis- 
sion to use it. 



CONTENTS 

pagb 

Introduction by Dr. Virgil P. Gibney ., ; ., ., xiii 

CHAPTER 

I. The Prospective Mother . «„ • i 

II. Mother's Teeth Before the Baby 

Comes .19 

III. Do's AND Dont'S FOR THE LAYETTE . 24 

IV. Baby's Bath , ., : „ . 30 

V. Maternal Nursing . . . ; . . 35 

VI. Milk Hygiene and How to Prepare 

the Formula 45 

VII. How to Decide on the Formula. 

By Dr. Charles Hendee Smith . . 53 

VIII. How to Give the Bottle .... 66 

IX. Weighing the Baby . . . ., . 71 

X. Proper Habits of Sleep . . ., . 76 

XI. Baby's Care in Hot Weather . -. 83 

XII. Constipation of Infants and Chil- 
dren .... 90 

XIII. Infectious Diseases . . . ., . 100 

XIV. How to Care for Infectious Diseases 

in the Home „ 108 

XV. The Birthright of Beauty . ., . 114 

XVI. Is My Baby All Right? . ., . .121 

XVII. Sudden Emergencies of Babyhood . 127 

ix 



X 

CHAPTER 

XVIII. 



XIX. 
XX. 

XXII. 
XXIII. 

XXIV. 

XXV. 

XXVI. 

XXVII. 

XXVIII. 

XXIX. 

XXX. 

XXXI. 

XXXII. 

XXXIII. 

XXXIV. 

XXXV. 

XXXVI. 



CONTENTS 

PAGE 

Important Points in Feeding During 
the Latter Part of the First Year 138 

Diet Schedules and Food Formulas 145 

How to Cook Vegetables for Chil- 
dren 158 

Colds — a Serious Menace . . .164 

Guarding Baby's Ears .... 168 

Children's Teeth — Even the Baby 
Ones Should Have the Utmost 
Attention 177 

The Care of Children's Feet . . 186 

Malnutrition and the Child . . 196 

The Child's Eyes 205 

Ophthalmia Neonatorum . . .212 

Fears of Childhood 217 

Factors Influencing the Nervous 
Health of Children .... 225 

The Activity of a Child and Why 
It Should Not Be Repressed . . 234 

The Child's Speech . . . . . 238 

Posture — the Foundation of a 
Child's Health 246 

Tuberculosis and the Child . . 256 

Now for Healthy Hearts . . . 262 

The Prevention of Diphtheria 
(The Schick Test) .... 271 

Poliomyelitis (Infantile Paraly- 
sis) 279 



CONTENTS 



XI 



CHAPTER 

XXXVII. 



PAGE 



Quarantine and Other Measures 
Against Infantile Paralysis . 286 



XXXVIII. The Right Food for School Chil- 
dren 293 

Brain-Fag in School Children . 

Cultivating the Speaking Voice 



XXXIX. 

XL. 
XLI. 



Sickness in the Family- 
But Invaluable Helps . 



299 
308 

-Small 
. . 316 

XLII. Palate Ticklers for the Little 

Sick-a-Bed 324 

XLIII. Play for Little Invalids . . . 330 

Bibliography 334 

Index ......... ( . m m . . 339 



INTRODUCTION 
By Dr. Virgil P. Gibney 

A statement made not long ago by the Bureau of 
Education of the United States Department of the In- 
terior revealed the fact that about fifteen million school 
children in this country were suffering from some 
physical defect which in infancy could have been pre- 
vented or corrected. This report further set forth 
that of these fifteen million handicapped children six 
million were malnourished. 

These statements considered in connection with other 
well known facts bearing upon the yearly infant mor- 
tality rate, the increasing mortality rates relative to 
childbirth and the all important relation of health in 
later life to the habits of childhood, bring strikingly 
before one the need for more and more education. 

Having been an eye-witness of many of the wonder- 
ful achievements of science, I heartily welcome, every 
contribution in the present, rapidly growing movement 
for the prevention of disease. We have learned that 
the most effective method of coping with disease is to 
prevent its occurrence or at least to bring treatment to 
bear in its earliest stages. And nowhere are the bene- 
fits of these teachings more strikingly illustrated than 
in connection with the child. 

xiii 



xiv INTRODUCTION 

When one considers the countless questions a 
mother or a prospective mother asks the family physi- 
cian, and his difficulty in many instances in giving a 
satisfactory explanation, no excuse need be offered for 
the appearance of a volume which covers the ground 
so fully and so lucidly as does the "Practical Talks on 
the Care of Children.' ' 

A glance at the table of contents will convince one, 
whether layman or physician, that the author has 
aimed to answer every possible question that concerns 
the welfare of the child. 

Text-books by eminent physicians in every special- 
ity require very little advertising to ensure a wide cir- 
culation. They are confined not alone to medical 
libraries but may be found in many homes throughout 
the land. With rare exceptions, however, these books 
are couched in technical terms and few mothers obtain 
the information they desire. 

In safeguarding the health of the children, the phy- 
sician's greatest ally is the professional nurse, not 
only the nurse called in after illness (to aid in restor- 
ing health) but the nurse, who with the ability to im- 
part her knowledge, becomes the mother's teacher, 
thus giving constructive assistance toward the making 
of that most valuable of all allies — the trained mother. 

While the physician and the nurse each have their 
respective fields, these must be coordinated. In this 
series of articles, which before their publication in 
leading magazines, were passed upon by prominent 



INTRODUCTION xv 

specialists, the ideas are complimentary and supple- 
mentary to the more technical viewpoint of the physi- 
cian. The author has not only treated the subjects in 
a simple, straightforward manner, but while grasping 
their scientific significance, she has with delightful 
simplicity made them easy of comprehension to any- 
one. 

And now let us take a glance at some of the chapter 
headings which indicate the progress which has been 
made during the last ten or fifteen years : — 

First (and perhaps I see this first, because it con- 
cerns my own speciality) is the chapter "The Care of 
Children's Feet." A comparatively few years ago it 
was not unusual to see small children with steel braces 
attached to their shoes for the relief apparently of 
weak ankles. In addition to other things, we have 
learned since then that it is very seldom, indeed, that 
steel apparatus is necessary. We have learned to re- 
gard the development of certain muscles on the inner 
side of the leg and ankle as of paramount importance 
in the relief of this ailment in older children; we have 
learned that if proper care is given to the question of 
nutrition in infancy, to the proper time when the child 
should begin walking, to correct dress of the feet and 
to the correction of wrong habits of muscular action in 
standing and walking, while the muscular system is 
immature, many of the foot distortions in later life 
with their trail of bodily ailments can be avoided. 
Indeed, if all parents would but grasp the full signifi- 



xvi INTRODUCTION 

cance of the relation of the feet to health, as Miss 
Bayley has explained it in this chapter, this alone would 
make the appearance of this volume well worth while. 

"Tuberculosis and the Child" and "Posture the 
Foundation of a Child's Health," coming as they do 
within my line of endeavor, also particularly attract 
my attention. While with Tuberculosis we have not 
developed any new scientific method for its treatment, 
we have learned the great importance of early diag- 
nosis and we have become more cognizant of the rela- 
tion of the infectious diseases (particularly whooping- 
cough and measles) as an exciting cause for a tuber- 
cular joint. 

So much have we learned within the last few years 
about the relation of posture to health, it would be 
difficult to give a clear outline here. The importance 
of the question is now so well recognized, there are 
physicians to-day who are devoting their entire time 
to this specialty. 

Further perusing these chapter headings we find 
"Fears of Childhood," "Factors Influencing the Ner- 
vous Health of Children," "Now for Healthy Hearts" 
and "Speech Defects" all of them dealing with com- 
paratively new developments in the field of Child Wel- 
fare. The first two subjects come within the scope 
of Mental Hygiene. This term while sounding per- 
haps cold and formal, really represents simple, common- 
sense principles dealing with environmental conditions, 
the emotions and general personality of the child. 



INTRODUCTION xvii 

Mental Hygiene and its application to the child, while 
to a large extent long neglected, has within the last 
few years been made the subject of profound scientific 
study, and while its scope is still being developed, psy- 
chologists, educators and those who have made a study 
of child life, recognize that while throughout child- 
hood attention should be given to Mental Hygiene, its 
value during the first seven years of life from the 
standpoint of habit formation, health, education and 
morals, cannot be overestimated. These two chapters, 
"Fears of Childhood" and "Factors Influencing the 
Nervous Health of Children," are worthy of study 
by all parents. The author has handled them deftly, 
bringing forcibly before the mother that habits of 
mind must be formed with at least the care given to 
table manners and social graces, and that in so doing, 
after all, the very simple things are the essential things. 
Since 19 16 when examinations of school children 
disclosed that from one and one-half to two per cent, 
of all school children examined showed some heart 
defect, the movement for the prevention of heart dis- 
ease among children has been the subject of serious 
endeavor. Begun in New York City by the establish- 
ment of an association for the Prevention and Relief 
of Heart Disease, the movement spread rapidly to 
other cities and up to January, 1921, special cardiac 
clinics had been established in thirteen other cities. 
In the chapter "Now for Healthy Hearts" the author 
has set forth in addition to the known causes for heart 



xviii INTRODUCTION 

disease among children, the most direct and effective 
measures from the standpoint of the mother, for pre- 
vention. 

The necessity for the prevention and early correc- 
tion of speech defects has since the war received new 
impetus. For it has been shown that not only were ten 
per cent, of those applying for commissions rejected 
because of poor articulation but also that men with 
well developed speech centers were less liable to shell 
shock. In other words, when the speech centers were 
well developed, the tendency to neurasthenia was les- 
sened. 

The correction of speech defects, a field so long 
attracting charlatans, has within the last few years 
been made the subject of much scientific study. In 
the chapter which Miss Bayley has devoted to this, the 
subject has been handled from the standpoint of 
prevention, that is, the early correction by the mother 
of those tendencies in childhood, which if allowed to 
develop may be the cause of much suffering both men- 
tal and physical in later life. 

The immunization of children against Diphtheria as 
described in the chapter "The Prevention of Diph- 
theria" is an entirely new development in the field of 
medical science. This is of particular educational value 
to the mother, in that it makes clear to her the great ne- 
cessity of cooperation with physicians (either in the 
home or school) in the elimination of this disease, 
having among children from one to five years of age 



INTRODUCTION xix 

almost as great a mortality as from measles and scarlet 
fever combined. 

Infantile Paralysis, a disease not becoming a seri- 
ous problem in America until the pandemic of 1907, 
is a subject on which we as yet know comparatively 
little. And yet through the subtle channels of recent 
bacteriological research methods, some definite con- 
clusions have been reached. The two chapters which 
the author has devoted to this subject give not only a 
concise history but the best known methods of preven- 
tion. And since the elimination of epidemics of In- 
fantile Paralysis (with our now limited knowledge) 
is a problem practically as much social as medical, 
these chapters are worthy of serious study by all 
parents. 

While in going over these chapter headings my eye 
was first attracted to those subjects mentioned in the 
foregoing, this in no way precludes the value and im- 
portance of the others. As I note the subject "The 
Prospective Mother," I am reminded again of that 
report by the U. S. Department of Labor, Children's 
Bureau, that in our country in 19 19, seventeen thou- 
sand, eight hundred mothers lost their lives from con- 
ditions caused by childbirth and that in a list of sev- 
enteen countries, the United States ranks seventeenth 
respecting maternal mortality. Needless to say that 
in addition to the establishment in every community of 
better facilities for the medical and nursing care of 
the mothers, there is yet need for the dissemination of 



xx INTRODUCTION 

more education to the prospective mother as to direc- 
tions for safeguarding her health and measures which 
may serve to prevent serious complications. 

In each and every one of the chapters which the 
author has taken up, while reading the subject matter 
itself, I have been particularly impressed with the de- 
tail and care taken in describing the necessity for each 
successive step in child care. 

This is an age in which we hear a great deal on the 
subject of eugenics. The result, however, of its ap- 
plication to the human race is so far off, it is difficult 
to get up much interest on the subject. In this series 
of articles, however, there are described practical, 
everyday methods for the improvement of not some fu- 
ture generation but of the generation with us. 
Through the investigations of modern medical science, 
we have gained a knowledge of the conditions which 
surround the development of the child and the general 
application of these principles will not only save the 
lives of many children but will develop a healthier and 
stronger race. 

One point I particularly desire to stress is that the 
things that may perhaps appear to the mother as little 
things, safely to be neglected, really make all the dif- 
ference in the world in the physical and mental health 
of the child. Just as an example (and those who 
study this volume will find many such examples) of 
small things making a vast difference, one need only 
consider the subject of the teeth and take into consid- 



INTRODUCTION xxi 

eration just how far-reaching are the results of their 
neglect even in early childhood. 

Through personal acquaintance I have known some- 
thing of the experience and knowledge of the author 
and believe she is presenting facts with which every 
parent should be familiar. I believe the value of this 
series is the greater because they are not the methods 
or writings of a specialist on any one subject. Miss 
Bayley, in addition to practical knowledge in all 
branches of child welfare work, has made careful 
research investigation (avoiding fads or unproven 
theories) and on various phases of the subject she 
has had direct assistance from physicians. 

In combination, these articles form not only a val- 
uable guide but a text-book for the mother. 



PRACTICAL TALKS ON THE CARE 
OF CHILDREN 



PRACTICAL TALKS ON 
THE CARE OF CHILDREN 

CHAPTER I 

THE PROSPECTIVE MOTHER 

The woman who realizes for the first time that a 
little life is dependent upon her stability for its future, 
should first of all succeed in making it welcome in her 
heart. For not only is there intimate physical union 
between mother and child, but undoubtedly mental 
and spiritual union. 

The thought of motherhood — life's greatest bless- 
ing — should cause no fear. Even the most intelli- 
gent women scarcely know what wonderful things 
have been done within the last fifty years to make 
motherhood safe. 

To the prospective mother, mental hygiene is quite 
as important as physical. So from the very first, she 
should do everything to insure for herself quiet of 
mind and freedom from anxiety. A restless, dissat- 
isfied woman cannot expect a child with a cheery, op- 
timistic disposition. 

From the very first, dismiss from the mind all 
thought of "maternal impressions/' or, in other words, 
that it is possible to deform the child by something one 



2 JHE CARE OF CHILDREN 

may see or hear. For scientists have long ago agreed 
there is no foundation whatever for this belief. 
These conclusions are supported by scientific facts. 
One of these being the two separate and distinct cir- 
culations. That is, the only communication between 
the mother and unborn child is an interchange of the 
materials of nutrition and excretion through the pla- 
centa. The food which the developing child needs 
is, by processes not clearly understood, extracted from 
the maternal blood and the waste products resulting 
from the child's growth are taken up by the maternal 
circulation and disposed of with those of the mother. 
This means, that since the mother's blood never enters 
the child, there is not, so far as known, any connection 
by which nervous impressions could be conveyed, even 
were it possible to convey them by means of the blood. 
On the other hand, it would seem that Nature has 
specially provided this barrier between mother and 
child as a protection from such injuries. There is, 
however, a way the mother may injure the child. 
That is, when she fails to order her life so as to endow 
the little one with a well nourished body and a stable 
nervous system. 

The expectant mother should at all times have medi- 
cal supervision. As soon as the fact of pregnancy 
has become established, she should at once place her- 
self in touch with a good medical practitioner, and 
remain under his care throughout the term. 

Pregnancy manifests itself, first, by probable and 



THE PROSPECTIVE MOTHER 3 

later by positive signs. The probable signs are: — 

Cessation of menstruation 
Changes in the breasts 
Morning sickness 
Disturbances in urination 

These are called probable signs because other causes 
may operate to produce them and they are, therefore, 
not infallible. 

The first of these signs (cessation of menstruation) 
is usually very significant, especially if there has been 
no previous irregularity. If this occurs twice in suc- 
cession, particularly in connection with the other signs, 
the condition of pregnancy may be definitely conceded. 

Changes in the breasts may be noted within a few 
weeks, such as: — 

Tenderness upon pressure, enlargement, darkening 
of the areolae (colored ring around the nipple) and 
a throbbing sensation, caused by distension of the 
superficial veins. 

Nausea (usually upon arising in the morning) while 
apparent in at least one-half of all cases, is particularly 
noticeable in the first pregnancy. This generally has 
its beginning about the time of the cessation of the 
first period and ends around the third month. 

Urinary disturbances may at first be troublesome. 
They are caused chiefly by pressure of the growing 
uterus against the bladder. These symptoms disap- 
pear during the fourth month, since at this time the 
uterus assumes a higher level in the pelvis. They may, 



4 THE CARE OF CHILDREN 

however, reappear during the ninth month when the 
uterus again begins to sink. 

Between the eighteenth and twentieth we'ek "quick- 
ening" or motion of the fetus may be felt by the 
mother. About this time also the physician upon 
listening with the stethoscope can distinctly hear the 
beating of the fetal heart. These are the earliest 
positive signs of pregnancy. 

The average duration of pregnancy is about two 
hundred and seventy-three to two hundred and eighty 
days or a little over nine months. There is no abso- 
lutely accurate way of computing the exact date of 
confinement. But the method considered most accu- 
rate is to count forward two hundred and eighty days 
from the date of appearance of the last menses. Or 
what is simpler and amounts to the same thing, count 
back three calendar months from the beginning of 
the last period and add seven days. This will give 
the month and approximate day. In first pregnancies 
labor may begin a week earlier and in others may 
occur later than this period. 

It is very important that the urine be frequently ex- 
amined. This should be done once a month during 
the first half and twice a month during the second half 
of pregnancy. When collecting urine for examina- 
tion, the quantity passed in twenty-four hours should 
be measured. If the amount is less than one quart or 
if the urine has a darkened color and shows sediment, 
you will need to drink more water. Conditions such 



THE PROSPECTIVE MOTHER 5 

as these are generally due to a too concentrated 
urine. They are, however, the only conclusions that 
can be drawn from its appearance. For the important 
abnormal constituents — albumin and sugar — make 
known their presence only in response to specific chem- 
ical tests. When collecting a twenty- four hour speci- 
men: 

Select a vessel with a cover and scald it thoroughly, 
then at some convenient hour, say 9 a. m., empty 
the bladder, throwing away this specimen. After this 
void into the vessel each time up to and including 9 
a.m. the next day, in the meantime keeping the vessel 
closely covered. For a specimen fill a perfectly clean 
small bottle (about 6 ounces), cork tightly, label, 
"twenty- four hour specimen" with your name, the 
date, the amount of urine passed in 24 hours and 
send at once to your physician. 

Any unnatural condition such as: 

Swelling of the hands or wrists, puffiness under the 
eyes, dizziness, blurring of the vision, repeated head- 
aches, muscular twitching or paroxysmal pains, es- 
pecially about the pit of the stomach, should be 
brought to the attention of the physician. They may 
or may not indicate the presence of serious toxaemia. 
But it is most important that all such symptoms be 
observed and reported. For it is only by this means 
and frequent examination of the urine, that the 
physician is enabled to know if there are indications 
of toxemia. And what is toxemia? 



6 THE CARE OF CHILDREN 

It is a poisoned state of the blood. As the child 
develops in the uterus, waste materials are constantly 
being thrown back into the mother's blood. And if 
her nutritional processes should be so imperfect as to 
make the elimination of these difficult, a condition 
more or less serious to both mother and child arises. 
This is called toxemia. If discovered in time, it may, 
by prompt treatment, be arrested. 

Exercise in the open air should be taken for at 
least two hours daily. In pleasant weather, walking 
is a valuable form of exercise. When weather con- 
ditions do not permit going out, one should try at 
least to walk on the porch. Near the end of preg- 
nancy when walking becomes fatiguing, one should 
sit as much as possible in the open air. Violent ex- 
ercise should always be avoided. And particular care 
should be taken not to become over-tired. This es- 
pecially applies to the last two or three months, as 
the nearer the end of the term is reached, the more 
work the heart is called upon to do. 

It is common for expectant mothers to tire easily, 
particularly during the early months. Take fully 
eight hours of sleep in a well ventilated room and 
rest for an hour or two during the day. 

During pregnancy the health of a woman should 
improve. She is usually better able to utilize her food. 
Take a normal, liberal mixed diet, avoiding all food 
known to cause distress, because of indigestion. 
While there is no need for the diet to differ materially 



THE PROSPECTIVE MOTHER 7 

from that to which one has become accustomed, it 
should be remembered that one of the most subtle 
causes of ill health at this time is malnutrition, due 
to lack of eating good nourishing food. An ideal 
diet consists of a small proportion of meat (once a 
day is usually sufficient), a generous allowance of 
easily digested vegetables and fresh fruits. Liquids, 
since they aid the kidneys, the bowels and the skin 
to throw off waste products, are particularly essential. 
About three quarts should be taken daily. Of this 
amount the larger part should be water, the remaining 
portion being made up of milk, cocoa, soups and 
(if desired) a moderate amount of tea and coffee. 
During pregnancy, if frequent small meals are taken, 
rather than three heavy ones, much discomfort may 
be avoided. Toward the end of pregnancy there will 
be an increased demand for heat and energy giving 
foods. For it is during the last eight weeks that the 
child gains half its weight. This increased demand 
should be supplied by the addition of milk to the usual 
diet. This should be taken between meals and at bed- 
time to avoid overloading the stomach and decreasing 
the appetite for other food. 

The decay of the teeth of the pregnant woman is 
largely due to the lack of lime and phosphorus in the 
diet. So too much emphasis cannot be put upon the 
necessity of a diet rich in minerals. Otherwise Na- 
ture robs the mother of her own supply to give to the 
child. Minerals are found in green vegetables, fresh 



8 THE CARE OF CHILDREN 

fruits and in cereals made from undenatured food 
products. The teeth should have a thorough exam- 
ination and be put in perfect order as soon as preg- 
nancy has been established. Use an alkaline mouth 
wash daily such as milk of magnesia or soda bicarb. 
(See Chapter II for further information on the teeth.) 
There is no more important consideration than to 
keep the bowels carefully regulated, lest congestive 
troubles, both functional and organic, should super- 
vene. Constipation is a common condition at this 
time. Fully ninety-five out of every hundred pros- 
pective mothers have to resort to some artificial means. 
The diet should include an abundance of fresh or 
cooked fruits for their laxative effect, and if vege- 
tables are eaten with olive oil this will also have a 
laxative effect. Graham and whole wheat bread, bran 
bread and corn bread, due to their coarseness, have 
a stimulating effect upon the intestines and for this 
reason, if there is a tendency to constipation, are very 
beneficial. If dietary measures are not efficacious 
senna prunes are a simple, effective and harmless rem- 
edy. To prepare : — Place in a covered jar an ounce 
of senna leaves, pouring over them a quart of boiling 
water. After they have stood from two to three hours, 
strain and throw away the leaves, leaving the clear 
liquid. To this add a pound of well washed prunes. 
Allow the prunes to soak in the liquid over night. In 
the morning, cook them slowly in the same liquid until 
one-half of the liquid has boiled away and the prunes 



THE PROSPECTIVE MOTHER 9 

are tender. A pint of water should then be added 
and the mixture sweetened with two tablespoonfuls 
of sugar, preferably brown sugar. Begin with half 
a dozen of the prunes with some of the syrup at the 
evening meal. They may then be increased or de- 
creased as required. The syrup has a stronger laxa- 
tive effect than the prunes. 

Drink plenty of water so the kidneys will act freely, 
as poisons are thus eliminated from the body. Take 
a daily tepid bath, but never a hot one. Do not allow 
the skin to become too chilled, as poisons are being 
constantly thrown off through the skin, and chilling 
makes it non-active, causing toxemia. In fact, free 
perspiration is one of Nature's most important safe- 
guards against complications, since it relieves the work 
of the kidneys, thus aiding them in maintaining health- 
ful activity. 

Should there be edema (swelling with fluid) of the 
feet and legs, it is wise to call this to the attention of 
the physician. Such a condition should, however, 
cause no alarm. For it is usually caused by pressure 
from the enlarged uterus obstructing the returning 
venous blood. This swelling is often reduced by sit- 
ting down as much as possible with the feet on a level 
with the hips. 

Varicose veins are also an indication that one should 
as much as possible keep off the feet. If very trouble- 
some, it may be necessary to bandage the legs with 
a thin flannel bandage before rising. 



io THE CARE OF CHILDREN 

When the baby arrives, his most urgent need will 
be that the mother should, during the early months 
of life, nurse him. In preparation for this the nipples 
must have some care. About two months before the 
expected date of confinement begin to harden the nip- 
ples by bathing with a saturated solution of boric 
acid and fifty per cent, alcohol, or by scrubbing thor- 
oughly, night and morning with a coarse wash cloth 
and rubbing with lanolin. After applying the lano- 
lin, cover with old linen to prevent soiling the clothing. 
Toward the end of pregnancy the breasts should be 
softened with a little vaseline each day and if the 
nipples are retracted gentle traction and manipulation 
should be made. This is done by grasping the nipple 
between the thumb and finger, drawing it out and 
allowing it to contract, doing this over and over two 
or three times daily. Do not bind the breasts with 
corsets or clothing. Do not wear tight bandages of 
any kind. 

It is from the first month to the middle of the 
fourth that a miscarriage is most likely to occur. 
During the first sixteen or eighteen weeks extreme 
care is necessary at the normal menstrual periods. 
One should avoid lifting heavy things, running up and 
down stairs, running a sewing machine, over fatigue 
and very hot baths. In case of vaginal bleeding or ab- 
dominal pain, go to bed at once, keep absolutely quiet 
and call a physician. 



THE PROSPECTIVE MOTHER n 

A douche should never be taken during pregnancy 
except under the advice of a physician. 

The ordinary type of corset can be worn until the 
beginning of the fourth month, when a regular mater- 
nity corset should be adopted. This corset should be 
cut so as to give good support to the abdomen and 
prevent sagging. Such a corset usually has three 
lacings, one in the back and one over either hip. A 
piece of elastic about two inches wide is incorporated 
into the full length of the corset on either side of the 
two front steels. The steels are more flexible than in the 
ordinary corset. This corset is ordered to fit the 
figure and is adjusted by the side lacings as the re- 
quirements demand. There are a number of good 
maternity corsets on the market most of them made 
after this type. In ordering such a corset, if at the 
fourth month, take the natural waist measure at that 
time for the size. Ordered at three months or less, the 
size would be two inches less than the waist measure. 

Since there is hardly anything more disturbing to 
nervous equilibrium than painful feet, shoes are an 
important factor to consider. It should be remem- 
bered that the body is larger and heavier and toward 
the end of pregnancy the feet may be swollen. For 
this reason the shoes should be larger than usual, and 
since high heels increase the risk of turning the ankle, 
tripping or falling, they should not be worn during 
pregnancy. The tendency of high heels to throw un- 



12 THE CARE OF CHILDREN 

due pressure on the lower part of the abdomen, al- 
ready under a strain, is another reason for discarding 
them during pregnancy. 

It is possible to have maternity clothing which 
is not only healthful, but comfortable, pleasing to the 
eye and inconspicuous, so the prospective mother need 
not deny herself the pleasure of going among her 
friends. 

The dresses should be cut with the line from the 
shoulder to the waist line in front, quite a little longer 
than the line in the back. This extra length of the 
waist line in front, which can be made to form a 
blouse effect, will prevent the dress from becoming 
shorter in front as pregnancy advances. Such a dress 
should be gathered in at the waist on an inside elastic 
belt. Added draperies have a graceful effect. If 
hung from the shoulders and designed properly such 
a dress will adjust itself to the increasing size of the 
figure. Each maternity dress should have a drop 
skirt. Aside from the house dresses the wardrobe 
should contain at least: 

2 well cut dresses, preferably made of some soft 

clinging material. 
2 negligees, made empire style. 
I wrap, which combines loose coat and cape lines. 

Maternity raiment is made by many prominent 
firms and may, by merely stating the size usually worn, 
be ordered by mail. Union underwear should be 
worn with or without sleeves according to the climate. 



THE PROSPECTIVE MOTHER 13 

The length of time one should remain in bed after 
the birth of a child is a question which has given rise 
to much discussion. While there are some advocates 
of a shorter or longer period, the majority of obstet- 
ricians advise at least ten days. The reasons for this 
may not have a bearing on one's general condition, 
that is, upon whether or not one feels able to be up 
and about, they relate more especially to the organic 
changes in process. While the ill effects of assuming 
one's duties too soon are not always immediately ap- 
parent, they lead all too often to operations in later 
life, especially is this true when one has failed to ex- 
ercise a degree of prudence after the birth of the first 
child. 

Do not use any kind of abdominal binder for at 
least two weeks after the birth of the baby. A binder 
worn too early may cause a retroflexed uterus (bent 
or turned backward). After two weeks a binder may 
be worn, if desired. 

The uterus does not return to its normal state for 
at least five or six weeks and until after this period ac- 
tive exercise should not be taken. 

What to Prepare for a Home 
Confinement 

While the wishes of individual doctors vary, the 
following articles will meet the usual needs of a home 
confinement : — 

Slop-jar or enamel bucket with cover 



i 4 THE CARE OF CHILDREN 

Three basins and two or three agate quart pitchers 

A douche-pan 

One and one half yards of rubber sheeting or oil- 
cloth a yard wide 

A two quart fountain syringe 

A stiff nail-brush 

A medicine glass, medicine dropper and bent glass 
drinking-tube 

Bichloride of mercury tablets (one small bottle) 

Chloroform (one small bottle) 

Boric acid powder or crystals 

Green soap, three to four ounces 

Castile Soap 

One pint of grain alcohol 

One jar of white vaseline 

Safety pins 

Fluid extract of ergot (one ounce) bought one week 
before confinement 

Plenty of hot water and cold sterile water (boiled 
water) at time of confinement 

Towels, sheets, pillow-cases and night-dresses 

It is now possible to obtain from some department 

stores, complete obstetrical outfits, sterilized and ready 

for use. The outfit, is, of course, less expensive if 

made at home. It should contain : — 

Five or six dozen sanitary pads, ten inches long by 
four inches wide. These are made of gauze and 
cotton. The pads should be about an inch thick. 
It will be more economical to use cotton batting 
for the greater part of each one, facing one side 
with a layer of absorbent cotton. The gauze 
should be cut wide enough to fold over the cotton, 
turning in the edges and long enough to extend 
two or three inches beyond it at each end. 



THE PROSPECTIVE MOTHER 15 

Two delivery pads, one yard square and four inches 
thick, made of gauze, and cotton batting or waste. 
Cotton batting may form the principal part of the 
thickness, but the top layer of absorbent cotton 
should be a least one inch thick. Less cotton will 
be necessary if newspapers (several thicknesses) 
are used for the bottom layer. The pads should 
be quilted or tacked at several points and each one 
should be wrapped separately. 

Four dozen gauze sponges. These are made by 
folding gauze, so it may be cut into fifteen inch 
lengths, the width of the gauze. The raw edges 
are then folded down about two and a half inches. 
The strip is then doubled by putting the selvage 
edges together. Fold this into thirds both ways, 
then turn the sponge inside out, so as to have all 
raw edges inside. 

Two or three dozen gauze squares. Gauze squares 
are simply four inch squares of gauze. 

Four or five dozen cotton pledgets. Cotton pledgets 
are wads of absorbent cotton, the size of a small 
egg, with the ends of the cotton twisted at the top. 
These should be placed in a small bag. 

Two sanitary belts 

Two yards of narrow tape or cotton bobbin, cut into 
nine inch lengths, to be used in tying the cord. 
Prepare six of these. 

One dozen towels and two old sheets 

Obstetrical leggings are very nice to have but not 
absolutely necessary. They are made of canton 
flannel cut somewhat like a stocking, except they 
are cut to fit very loosely and should reach to the 
hip. If cut so as to extend to the waist at the 
sides, they may be held in place by a band made 
of stout muslin. They will in this way prevent 
unnecessary exposure without interfering with the 



16 THE CARE OF CHILDREN 

doctor. If obstetrical leggings are used they 
should be sterilized with the other articles. 

The dressings should be wrapped in unbleached mus- 
lin, each lot in a separate package. Pins should be 
used to secure the packages, but the points should 
not be exposed, only the heads of the pins. While 
the dressings may be sterilized by baking in the 
oven, steaming is a much more effective method. 
A small wash boiler about one third full of water 
makes a good receptacle for this purpose. Se- 
cure the dressings into an old sheet fashioned into 
a hammock, securing each end to the boiler han- 
dles. The center of the hammock should ex- 
tend into the boiler less than one half way. 
Cover should be applied to the boiler and the 
dressings allowed to steam over the boiling water 
for about an hour. They should then be placed 
in the sun to dry or in the oven, with door open. 
After twenty-four hours the dressings should be 
steamed a second time, dried as in the first in- 
stance, then placed in a tightly covered box. 

Layette 

Three abdominal bands, 6 to 8 inches wide and 20 
inches long, soft flannel strips unhemmed. 

Three silk and wool or cotton and wool shirts (not 
all wool). Shirts come in four weights and sev- 
eral sizes. It is well to begin with the second 
size as the first is soon outgrown. The shirts 
should be high neck and long sleeves (lighter 
weight for a summer infant). They should open 
all the way down in front. 

Four flannel skirts, "Gertrude" style. That is with 
button and button-hole on each shoulder. This 
type of garment prevents unnecessary handling of 
the child. 



THE PROSPECTIVE MOTHER 17 

Eight white slips, 28 inches shoulder to hem. These 
should be made of some very soft material, such 
as, cambric, nainsook, long cloth or batiste. 

Five dozen cotton diapers (second size). These 
should be made of "bird's eye." 

Three pairs of socks, if in summer; three pairs of 
long white merino stockings, if the weather is 
cold. 

Three night gowns or wrappers of outing flannel. 

Challis, nun's veiling, cashmere, henrietta cloth, 

or any other light soft material may be used for 

this purpose. Stockinette also makes a very 

satisfactory night gown. 

Cloak (Baby Bunting coat and hood in one) if in 
winter, baby blanket, cap, carriage blanket of 
crocheted or knitted wool. 

Three knitted bands, with shoulder straps, part wool. 
These should be used in place of the flannel bands 
after first few weeks. 

The coat for a Summer baby may be made from 
some light weight material like cashmere or from 
silk and wool material. This may be used in the 
Fall, with a warm lining under it, until it is time 
for the heavier Winter coat. 

The Baby's Basket 

This should contain an old soft clean shawl or 

blanket — to receive the baby at birth. 
A package of nickel plated safety pins, three sizes. 
A roll of sterile gauze. 

Squares of old linen, to be thrown away after using. 
Absorbent cotton. 
Cake of Castile Soap. 
Two ounces of boric acid. 
Four ounce bottle of olive oil or sweet oil. 
Talcum powder. 



i8 



THE CARE OF CHILDREN 



Hot water bag with flannel cover. 
Infant's soft hair brush. 
Jar of white vaseline. 

A small pair of scissors with rounded ends. 
A package of wooden toothpicks. 
A bath thermometer. 
Six of the best baby towels. 

A white eiderdown blanket, one and one half yards 
long. 



CHAPTER II 



mother's teeth before the baby comes 



That the prospective mother must expect to lose a 
tooth or more for each child is a fallacy which has 
been slow to hide away into the shadows of the past. 
Why has it been so difficult to banish this belief? 

Because during pregnancy the teeth are more sus- 
ceptible to decay, and many women do lose some of 
their teeth at this time. 

This susceptibility is thought to be explained by : 

i. The demand Nature makes upon the system for 
lime salts needed in building the child's skeleton. 

2. The acidity of the saliva, caused by the regurgi- 
tation of the acid contents of the stomach. This 
reason is probably the most plausible^ especially if 
there has been much nausea during the first three 
months. 

Trouble with the teeth during pregnancy is not, 
however, a natural condition. It may be avoided by 
giving them the proper care. 

As soon as conception is known, every woman 
should begin to take the most painstaking care of her 
teeth. She should at once visit a good dentist, have 
her teeth cleaned and necessary repairs made. If den- 
tal work is done early in pregnancy, and the dentist is 

19 



20 THE CARE OF CHILDREN 

told of the woman's condition, there is no reason to 
suppose it can cause any ill effects. The only element 
of danger that exists is the possibility of a shock 
sufficient to cause a miscarriage. When the dentist 
is told of the condition, even this danger does not ex- 
ist, as he will not then undertake any painful or ex- 
tensive work. 

There still exists among some the old superstition 
that dental care to the prospective mother may pro- 
duce birthmarks upon the child, especially that it may 
cause what is known as a cleft palate. When the cleft 
palate does occur, it is due to non-union of the supe- 
rior maxillary bones, and occurs during the second 
month of pregnancy; it has no connection whatever 
with the theory of what is known as "maternal impres- 
sions." 

Furthermore, aside from the fact that scientists 
have now practically agreed that there is no basis 
whatever for any belief in "maternal impressions/ ' 
fetal development is too far advanced before the mother 
is even aware of her condition for any dental care to 
affect the developing child. 

On the other hand, the harm resulting from a neg- 
lected mouth can hardly be estimated. Not only may 
some of the teeth be lost, but the septic materials har- 
bored are a constant source of infection to the mother, 
and symptoms of the gravest and most diversified 
character may arise. In some instances the poisons 
taken into the system from a diseased mouth seriously 



MOTHER'S TEETH 21 

interfere with the nutrition of the fetus. Since the 
first teeth begin to calcify about the seventeenth week 
of pregnancy, and the first permanent molars begin 
to form a few weeks later, poor fetal development 
may result in a poor grade of teeth which will always 
be a handicap to the child; furthermore, long persist- 
ent sources of infection such as decayed teeth, root 
abscesses and diseased gums, militate against success- 
ful nursing of the child. 

Writing on "Dental Diseases in Nursing Woman," 
in the Lancet, Dr. Harold Waller points out that from 
experience with two hundred nursing women with 
dental disease, he found in many instances that in- 
fants who were backward in development at once be- 
gan to gain normally when the mother's mouth-in- 
fection had been cleared up. 

After the prospective mother has had her teeth put 
into condition by the dentist, she should be careful 
to use dental floss and to wash them after each meal 
and before retiring; she should also rinse the mouth 
with some alkaline wash after each attack of vomiting 
or eructation of gas. A teaspoon ful of milk of mag- 
nesia or a half-teaspoonful of baking-soda dissolved in 
a glass of water, makes an excellent alkaline wash. 

After the tooth-brush has been used, it should be 
soaked in alcohol for a few minutes for cleansing 
purposes and then rinsed. It is better to have two 
brushes, using first one and then the other. If the 
gums bleed while brushing the teeth, do not let this 



22 THE CARE OF CHILDREN 

deter you. The brushing will not injure them. If 
the gums are massaged with the finger-tips once or 
twice a day, using the thumb and forefinger, rubbing 
toward the cutting edge of the tooth, it will have a 
stimulating effect and will aid in returning them to 
health. Should the bleeding continue, it would be well 
to ask your doctor or dentist for an astringent mouth- 
wash. Healthy gums are always hard, and cling very 
closely to the teeth. 

As the circulation is always sluggish during preg- 
nancy, the gums are apt to be poorly nourished, mak- 
ing this period one of the most susceptible for the de- 
velopment of pyorrhea, sometimes called "Riggs' Dis- 
ease. " An unclean mouth is the very first stage of 
pyorrhea. Unless the teeth are carefully brushed, the 
food which clings to them causes tartar to form about 
the roots of the teeth. This tartar then presses on the 
tissues beneath it, interfering with the circulation; 
these tissues, then lacking sufficient resistive power, 
are invaded by pus- forming bacteria. The gums be- 
come swollen and red, and pus forms in the tooth- 
socket. 

Once pyorrhea has developed, it becomes a serious 
menace to health, even to life itself. It may be pre- 
vented by regular cleansing of the mouth and teeth. 

From decayed teeth, root abscesses and pyorrhea 
develop such diseases as: 

Acute or chronic rheumatism, arthritis, cardiac le- 
sions, neuritis, neuralgia, sciatica, digestive disturb- 



MOTHER'S TEETH 23 

ances and neurasthenia, as well as anemia and general 
debility. 

To the prospective mother the care of the teeth is a 
matter of vital importance. 



CHAPTER III 
do's and don'ts for the 

LAYETTE 

In the old days when a baby cried long and lustily, it 
was supposed to have colic or to be hungry. We 
know now it is frequently an indication of some physi- 
cal discomfort. Very often this has to do with the 
clothing, a button, rough seam, safety-pin, or even a 
harsh thread in the material, digging into his tender 
smooth baby flesh. 

Dressing an infant correctly is very important. It 
has much to do with his health and happiness. The 
key-note of the first wardrobe should be simplicity, 
lightness and softness. Fashion and furbelows should 
not enter into the scheme of things. A large assort- 
ment of various kinds of clothing is sheer extravagance, 
not only of the mother's strength but of materials. 

There should be at least eight slips for use by day. 
Select some very soft material such as nainsook, 
long-cloth, batiste or cambric. They should be of 
standard length, which is about twenty-eight inches, 
shoulder to hem, and should be very simply made as 
eczema may be caused by irritating the tender skin. 
Special care should be used to avoid having anything 

24 



DO'S AND DONTS FOR LAYETTE 25 

about the neck that might scratch or irritate. Starch 
should never be used in any part of a baby's outfit. 
Everything must be soft. 

Four flannel petticoats are sufficient. They should 
be of light-weight part-wool flannel, made after the 
Gertrude or princess pattern. Petticoats should al- 
ways hang from the shoulders and may be fastened 
by means of two straps on each shoulder. 

The question of the shirts is a knotty problem, as 
about this little garment there is only one point on 
which all factions seem to agree, which is, that it should 
be opened all the way down the front. The most 
suitable material is the unsettled question. The all- 
wool garment is not so much in favor as it once was. 
The objections voiced against this are that it does 
not absorb perspiration, that the child is made too 
warm, becomes unduly sensitive and for this reason is 
a more ready prey to infection. 

Linen mesh has many advocates as ideal for both 
winter and summer, the argument for this being that 
air space in clothing, as well as in buildings or refrig- 
erators, stops the passage of either heat or cold and 
that this material is absorbent and non-irritating. 
Cotton and wool or silk and wool as the best materials 
have, however, the largest number of champions. 

Infants' shirts come in four weights and several 
sizes. To prevent outgrowing so soon, begin with 
the second size. There should be a winter weight and 
a summer weight. Four of each is the minimum. 



26 THE CARE OF CHILDREN 

As there is no diaper fit to be used a second time 
without having been carefully washed and dried, four 
dozen is the least one should provide. They should 
be made of fine quality bird's-eye cotton or linen 
diaper-cloth, twenty by twenty inches. The diaper 
should be folded diagonally and then folded again, 
making four thicknesses of material. A piece of soft 
old linen, for further protection, may be laid inside 
the diaper just before it is adjusted. 

Cutting the material large enough to allow for more 
than two folds (four thicknesses) is not advisable. 
A diaper at best is hot and more or less clumsy, while 
there is some evidence that thick wads between the 
thighs may promote deformity of the bones. In ad- 
justment, care should be exercised not to pin too tightly 
about the hips or over the thighs where the two sides 
are pinned together, as this will interfere with the cir- 
culation. 

Diapers should be washed with a pure white soap, 
thoroughly rinsed and dried in the open air. Until 
they are washed, keep in a covered pail, as intestinal 
disorders among infants are not infrequently carried 
by flies from carelessly exposed soiled diapers. 

The fitted rubber article so frequently seen should 
not be used. This is particularly pernicious on ac- 
count of the heating properties of rubber. During the 
day, the diaper should be changed whenever soiled and 
at night when the baby is taken up for feeding. 

The bands or binders should be made of unhemmed, 



DO'S AND DONTS FOR LAYETTE 27 

soft white flannel. They should be cut on the bias 
and into strips six to eight inches wide and eighteen 
inches long. 

When applying the band, it should be rolled gently 
around the baby's abdomen and sewed smoothly into 
place; it should not be secured by means of safety-pins. 
The object of the band is primarily to protect the cord 
dressing until the navel has healed. It should never 
bind. If drawn too tightly, instead of preventing 
rupture, it may produce it; especially is this true if 
the pressure is made in the wrong place. A band 
that binds will also interfere with respiration and may 
cause vomiting and colic. 

After the first few weeks a knitted band with 
shoulder-straps should be substituted, as after this 
time the abdominal muscles need free play in order that 
they may become strengthened. 

The knitted band should be worn night and day 
for the first three or four months. If the baby is 
frail or delicate, it should be worn as long as eighteen 
months, as chilling of the abdomen is thus prevented. 
Four bands of each kind should be sufficient. 

The nightgowns should in a general way follow 
the style of the slips. They should be made long 
enough so as to close at the bottom by buttons or 
drawing-strings when the baby's feet have become ac- 
tive. In winter they should be made of cotton flannel 
or some other warm material and should, of course, 
be used without a petticoat. In summer the night- 



28 THE CARE OF CHILDREN 

gowns should be made of some soft cotton material. 

When the baby is prepared for bed, his apparel 
should be changed throughout. While the little shirt 
need not necessarily be laundered each time it is 
changed, he should not wear the same one at night 
which had been worn throughout the day. Six night- 
gowns will be required. 

There should be four pairs of merino stockings 
(mixture of cotton and wool). When the weather is 
warm the baby may not need stockings, but when it 
grows cool toward night, stockings should be used. 
The stockings should meet the diaper, leaving no part 
of the leg exposed. When the baby begins to creep 
around on the floor, soft-soled shoes will be necessary. 

Two knitted or flannel sacks and two wrappers are 
essential for cool weather. If the sacks are cro- 
cheted, select a light yarn, and if made of cloth, let the 
material be light and soft. The wrapper should be of 
cotton flannel, henrietta cloth, challis, cashmere or any 
other soft material readily washed. It should button 
down the front and reach several inches below the 
feet. 

As fresh air is very important, the wardrobe should 
contain a cloak of some warm, soft, woolen material. 
This should be made long enough to reach from the 
baby's neck to from four to six inches below his feet 
and wide enough to lap over his entire chest on each 
side. 



DO'S AND DONTS FOR LAYETTE 29 

The cap for winter may be of silk with an inter- 
lining of flannel. For milder weather, silk or muslin. 
Among the accessories there should be six bibs and 
two afghans. 



CHAPTER IV 
baby's bath 

A healthy baby should be bathed every day. 
The tub bath should begin as soon as the navel-scar 
has fully healed. An infant's bathtub will answer 
for the first year of a baby's life, in fact until he has 
grown too large for it. 

A baby should not be bathed for fully an hour after 
feeding. The temperature of the room should be 
from seventy-two to seventy-three degrees. It is not 
wise to have it hotter than this, as after the bath is 
over and the temperature of the room is suddenly re- 
duced or the baby is taken in another room of a lower 
temperature, he may become chilled. 

Now, having the room at the right temperature, the 
next step is to get everything ready for the bath, so 
there will be no delay once it has been started. Be- 
fore picking up the baby, have everything that you are 
going to use right at hand. There should be a tray- 
basket or some receptacle always kept equipped with 
the necessary things for the baby's bath. This should 
contain : 

Two wash-cloths (one for the face and one for the 
body), two old soft towels, pure white soap, safety- 

30 



BABY'S BATH 31 

pins (large and small), a powder-shaker, absorbent 
cotton (kept in a jar with a top on it), tooth-picks, 
a jar of vaseline, a clinical thermometer and a bath 
thermometer. 

There should be a low stool or low wooden chair on 
which to set the bathtub, and the mother should place 
just opposite this another chair for her own use. This 
chair should, however, be a little higher than the one 
on which she has placed a full change of clothing for 
the baby. 

The articles should all be placed in a pile on the 
chair in the order in which they will be used in dress- 
ing the baby. A bath-blanket and a bath-apron 
should be near at hand on the back of one of the 
chairs. 

A screen should be placed near by to shield the baby 
from drafts, and if this is not at hand, one can easily 
be improvised by hanging a blanket over two chairs. 
Having all these things in readiness, prepare the bath- 
water. 

The temperature of the water should be from 
ninety-eight to one hundred degrees Fahrenheit. It 
should be tested by means of a bath thermometer, but 
if none is at hand, dipping the elbow into the water 
is a good test. If neither too hot nor too cold for the 
elbow, but just comfortable, it is about right for the 
baby. It is well to have the water a little warmer than 
this to begin with so as to allow for cooling while un- 
dressing the baby, washing the face and ears and 



32 THE CARE OF CHILDREN 

cleaning the nose, but always test it before putting the 
baby in the tub. 

Now put on your bath-apron, take the baby on your 
lap, quickly undress him and fold the bath-blanket 
around him, not forgetting to place a napkin between 
the blanket and the baby. 

First, wash the face, while the baby is wrapped in 
the blanket. Do not use any soap for the face. It 
is not necessary to bathe the eyes with boracic acid or 
any antiseptic, as long as they appear normal, merely 
washing them very gently with the face-cloth. 

In cleansing the ears, wash the external parts with a 
soft rag and carefully dry them, as well as the creases 
back of the ear, but do not attempt to clean the ear by 
introducing anything inside the canal, such as a tooth- 
pick or a match wrapped with cotton. The cloth may 
be stretched over the little finger and the outer ear 
cleansed. 

The mouth of a baby does not need cleansing until 
after the teeth have come and any attempt to do so may 
cause harm by scratching the delicate tissues. 

After these details, make a lather of soap on the 
palms and soap well the baby's scalp, using care to 
avoid getting soap into the eyes. Now change the 
position of the baby, so that the head is over the bath- 
tub, while the baby's back is being supported by your 
arm and the back of his head rests in the palm of your 
hand. In this position, with the baby's head slightly 



BABY'S BATH 33 

lowered, to prevent water running into the eyes, wash 
away all the soap lather with the wash-cloth in your 
right hand. Let the baby rest on your lap while you 
dry the head thoroughly. 

Now, unfold the bath-blanket from around the baby 
and while he is resting on your lap, soap the entire 
body. Then with your right forearm under the legs, 
the hand under the buttocks and your left forearm un- 
der the neck and shoulders, with your left hand under 
his arm, lift him quickly into the tub. While in the 
tub keep your left forearm and hand in the same posi- 
tion, while with your right hand you sponge the entire 
body. 

Now place a large warm towel on the bath-blanket 
in your lap, lift the baby out of the tub and wrap in 
the towel, and with a soft towel, begin to dry him, not 
by rubbing, but by gently patting the skin. After 
the skin is good and dry, remove the bath-towel, place 
a napkin under the buttocks, and draw the folds of 
the blanket about him. 

Too much powder is decidedly worse than none. 
After the skin is good and dry, a little talcum-powder 
may be used under the arms and in the folds of the 
skin, but wherever there are signs of redness or 
chafing, a drop or two of olive-oil rubbed on with the 
finger will be more effective than powder. 

In dressing the baby, do so quickly and be very care- 
ful to keep him covered as much as possible. Do not 



34 THE CARE OF CHILDREN 

keep lifting and turning the baby while dressing him. 
Generally a baby can be dressed completely while ly- 
ing on his back, after which he may be turned on his 
face while the garments are fastened. 



CHAPTER V 

MATERNAL NURSING 

One of the great problems of the day is the proper 
feeding of infants and children. Whatever may be 
the difference of opinion, there is one fundamental 
principle on which all experts agree; that the ideal 
food for a baby is the milk of a healthy mother. 

Aside from other important facts, bearing on nutri- 
tion and infection from unclean milk, the breast-fed 
baby is undoubtedly provided with a certain measure 
of passive immunity against possible infection by 
disease. This is thought to be due to certain antitox- 
ins which pass from the mother to the child in human 
milk. In bottle-fed babies this immunity is not main- 
tained. 

As statistics have proven so conclusively that breast- 
fed babies are more likely to live; that they are more 
vigorous and more resistant to disease, it should be 
the ambition of every woman who becomes a mother 
to nurse her child during the first nine months of life. 
For not only will she be supplying the food intended 
by Nature, but insuring to her baby many more chances 
of life. 

Successful nursing requires that one be well bal- 

35 



36 THE CARE OF CHILDREN 

anced mentally and physically. This means that the 
emotions must be under control and the nerves well 
poised; there must be regular habits with good diges- 
tion and healthy blood as well as normal conditions of 
the nursing organs. As these mental and physical 
conditions result only from proper living through 
many years, it can easily be seen that the living con- 
ditions and habits of life of the growing girl have a 
most intimate bearing in fitting or unfitting her for 
this most important function. 

Certain common sense rules of life have a direct bear- 
ing on successful nursing and as a preparation for 
maternal responsibility the prospective mother should 
give special attention to these. (See Chapter I.) Of 
equal importance with the physical preparation is 
the cultivation of a calm mind free from worry and 
fear. There are few conditions so variable and so un- 
certain as the production of breast milk. It is se- 
creted by a wonderful and delicate mechanism called 
the mammary glands. There is no doubt that the 
nerves feeding these glands have an intimate relation 
with the mind, for their function is readily influenced 
by the mental states of the mother. 

The clothing should be amply loose to allow for 
development of the breasts and to prevent depression 
of the nipples. 

Nursing will be made easier for the baby and more 
comfortable for the mother if, during the last two 



MATERNAL NURSING 37 

months of pregnancy the nipples receive special and 
regular attention. (See Chapter I. "The Prospective 
Mother.") 

The baby should be put to the breast as soon as the 
mother has rested and sufficiently recovered from ex- 
haustion. While the milk does not appear in the 
breast until from 48 to 72 hours after birth, there is 
a semi-opaque fluid secreted called Colostrum. This 
not only may satisfy the child but it is thought to act 
as a laxative to the baby, clearing the intestines of the 
waste material which they contain at birth; a further 
advantage of the baby's efforts at nursing is its stim- 
ulating effect upon the mammary glands which secrete 
the milk, also it prepares both the nipple and the in- 
fant for what will be required later. 

If it so happens that the baby is unwilling to nurse, 
he should nevertheless at regular intervals be given 
the opportunity and after awhile he will become 
hungry enough to make an effort to get his food. In 
the meantime, he should be given from one-half to 
one ounce of boiled and slightly warmed unsweet- 
ened water every two hours until nursing is estab- 
lished. 

Before and after each nursing the nipples should 
be washed with a saturated solution of boric acid. 
This is made by dissolving one teaspoonful of boric 
acid crystals in a glass of boiled water. The solution 
should be made fresh every day. Fissures or cracks 



38 THE CARE OF CHILDREN 

often result from omitting this care of the nipples. 
Unceasing care in this respect is especially necessary 
during the first few days. Between nursings the 
breasts should be kept covered with sterile cotton, 
gauze or a clean handkerchief, and this should be 
changed daily. If at the beginning of nursing, the 
nipples are sensitive they may be protected by a ster- 
ilized glass and rubber shield. A baby should never be 
allowed to nurse on a cracked or fissured nipple but 
the breast shield should be used until healing has 
taken place. Apply local applications of tincture 
of benzoin, or use a salve made of one-half 
ounce of vaseline, one drachm of lanolin and one- 
half ounce of aristol. The mother should avoid han- 
dling her breasts except with clean hands as there 
is danger of introducing foreign material through 
the nipple opening or a break in the skin. This 
may cause an infection and result in a breast ab- 
scess. 

For the first day, the baby is usually put to the 
breast once in six hours; second day once every four 
hours, and on the third day, after the milk has come, 
every three hours. There should be in the twenty- 
four hours 7 nursings. That is, from six a. m. to ten 
p. M. there should be 6 with one nursing at two or three 
a. m. After the baby becomes older and is well started, 
the tendency is to lengthen the intervals. We are 
giving opposite a schedule which may be followed: — 



MATERNAL NURSING 39 

Nursing Interval Night Nursings 

in 24 by Day 10 p.m. to 

Age hours {hours) 6 a.m. 
3rd day to 
end of 3rd 

month 7 3 1 

3rd month 

to 
5th month 6 3 

5th month 

to 
1 2th month 5 4 

The baby should from the beginning be trained to 
regularity in nursing. This is most important, not 
only from the standpoint of the baby's digestion 
and assimilation, but the breast which if emptied at 
regular intervals secretes more and better milk. The 
establishment of regular nursing habits also enables 
the mother to secure more sleep at night and this aids 
the milk supply. 

To promote the supply of milk the nursing mother 
should cultivate self-control and a quiet mind. 
She should have an abundant, wholesome diet and at 
least eight hours sleep out of every twenty- four, rest- 
ing for an hour or two during the day if her nights 
are disturbed. Outdoor exercise which is always 
desirable is particularly necessary for the nursing 
mother, but to secure the best results, this should not 
be carried to the point of fatigue. Any food not 
causing indigestion is a safe food so far as nursing 



40 THE CARE OF CHILDREN 

is concerned and the appetite is a reliable guide both 
as to choice and quantity. Generally speaking, the 
diet should be a mixed one, consisting of milk (not 
more than one quart daily) cereals, soups, eggs, meat, 
fish, poultry, vegetables, bread and plenty of fruits. 
In other words, all is milk-making food and no sharp 
line between the various kinds can be drawn. Tea 
and coffee should be taken sparingly. Water, since 
it forms a large proportion of milk, should be taken 
very freely. There is a widespread belief that acid 
vegetables, such as the tomato, acid fruits and salads, 
should not be taken by the nursing mother for fear 
the acids will affect the milk and give the baby colic. 
This belief is erroneous. All acids are changed in the 
process of the mother's digestion and cannot enter the 
milk. The only articles of food that should be ex- 
cluded from the diet, for fear of an unfavorable 
effect upon the milk, are those which from experience 
the mother knows she cannot easily digest. 

Take your meals regularly and in addition two or 
three glasses of milk, between meals and one before 
retiring. This extra nourishment should be taken 
about one and a half hours after breakfast and lunch- 
eon in order that it may not lessen the appetite for 
the regular meals. If the breast milk is not plentiful, 
drink cocoa and at bed time take eight ounces of oat- 
meal or cornmeal gruel with eight ounces of milk. 

The condition of the bowels is a very important 
matter for the nursing mother. She should guard 



MATERNAL NURSING 41 

as carefully against constipation during the nursing 
period as during pregnancy. One free evacuation 
daily is most essential. Drugs should not be taken 
except upon the advice of a physician, as many of 
these are secreted in the milk and thus affect the baby. 
It is a condition which should be treated by hygiene 
and diet. At nursing time the mother and baby should 
be in a quiet comfortable place free from interruption 
or excitement. 

The mother should sit in a low chair with the 
baby in the hollow of her arm. The breast should 
be held away from the baby's nose, so he can breathe. 
Ten to fifteen minutes is long enough for most babies 
at a nursing. Very often when there is a great supply 
of milk, and the baby is a vigorous nurser, five to 
seven minutes is sufficient time at the breast. Only 
one breast should be given at a nursing, if the milk is 
plentiful, but if there is not enough in one breast, give 
both, allowing at each breast five to ten minutes. 
After nursing, the baby should be held against the 
shoulder and patted gently on the back, in order that 
he may get the air up from his stomach. Then put 
him down to rest or sleep. If, however, he seems 
not to be comfortable, after a few minutes take him 
up and hold against the shoulder, to see if he cannot 
bring up more gas. 

The importance of safeguarding the mother from 
worry and excitement cannot be overemphasized, for 
there is certainly no other one thing which so greatly 



42 THE CARE OF CHILDREN 

interferes with the secretion of milk as an over- 
wrought nervous system. Great emotional disturb- 
ances such as worry, anger, fear or grief, may not 
only check the secretion but they produce poisons in 
the blood which are secreted in the milk. By reason 
of these poisons the milk then becomes dangerous for 
the baby. 

If the mother has been greatly disturbed by any 
of these, she should not nurse her baby for several 
hours afterwards but should withdraw the milk by 
means of a breast pump. The baby in the meantime 
may be given a feeding of barley water. 

The mother should never give up the attempt to 
nurse her baby without competent advice, as it not in- 
frequently happens that nursing at first unsatisfactory, 
will later develop perfectly. And even if this does not 
prove to be the case, even a small amount of milk is 
of great aid to the baby, especially during the first 
three months. 

The signs of successful nursing are: First, a sat- 
isfied, happy baby, and, if under three months of age, 
content to fall asleep at the end of ten or at the most 
twenty minutes nursing; two or three soft yellow 
stools daily and a weekly gain in weight of not less 
than four ounces. 

If the baby remains for long periods at the breast; 
cries when he is removed; shows signs of hunger 
long before the nursing hour; cries, vomits or has 
colic after he finishes nursing, and fails to make any 



MATERNAL NURSING 43 

appreciable gain in weight, the nursing is unsatis- 
factory. 

Such symptoms seldom mean that the baby should 
be weaned but usually are an indication that the 
mother has not sufficient milk and that the breast feed- 
ing should be supplemented by artificial feeding. 

The amount of milk the baby is getting from the 
breast can be determined by weighing him with his 
clothes on, before and after each nursing, for a period 
of about twelve hours, carefully putting down the re- 
sult. At the end of the period by adding the different 
amounts together it will be possible to determine the 
amount of milk the baby has gotten during this time. 
After knowing this, it is possible to determine how 
much and how many supplementary feedings are nec- 
essary. In a situation of this kind it is essential to 
have the advice of a physician (preferably one special- 
izing in the treatment of infants and children) to 
start the mother on the proper supplementary feeding. 

Occasionally unsatisfactory feeding is caused by 
the milk being too strong or too weak, that is, the 
normal proportions of fat, sugar and proteid are 
not maintained. These errors are determined by ex- 
amination of the milk and are usually easily corrected 
by the advice of a physician. 

As soon as it has been demonstrated that nursing is 
satisfactory, many physicians advise giving the baby 
one bottle feeding daily. The advantages of this are 
threefold. In case the mother should have an acute 



44 THE CARE OF CHILDREN 

illness with fever (which always calls for temporary 
discontinuance of nursing) the baby's feeding is pro- 
vided for; it gives the mother more freedom and 
chance for recreation and finally weaning is made 
easier by reason of the baby having been accustomed 
to the bottle feeding. In beginning with the daily 
bottle, at first a weaker formula should be given than 
that corresponding to the age of the baby, gradually in- 
creasing to a formula of the strength required for his 
age. 

The baby should not be weaned earlier than the 
ninth month or later than the twelfth. This should be 
done gradually, so in case of illness he can be put back 
on the breast. Begin by giving one less nursing every 
second or third day until only two are given. Con- 
tinue these two nursings for about a week after which 
they may also be discontinued. 

When weaning a baby, while it is usually possible 
after the tenth month to give three parts whole milk 
and one part cereal water, the mother should consult her 
physician, as this is a period often overtaken by evil. 



CHAPTER VI 

MILK HYGIENE AND HOW TO PREPARE THE 
FORMULA 

When the problem of artificial feeding is presented, 
an inexperienced mother often is at a loss as to just 
how and where to begin. 

The first consideration is to secure the proper for- 
mula. To formulate a proper milk for any child re- 
quires knowledge and experience which a mother can- 
not be expected to possess. It should not be under- 
taken without the advice of a good physician, when 
one is available. 

While there is no perfect food that can take the 
place of mother's milk, it is generally considered that 
cow's milk properly modified, that is, adapted to the 
age and peculiarities of the child, is the best substitute. 
On the other hand, there are some food preparations 
which are very helpful in the feeding of delicate in- 
fants, particularly those unable to tolerate modified 
cow's milk. To experiment, however, with these foods, 
with different mixtures of cow's milk, or to attempt to 
feed the baby after the method of a neighbor, is a 
very unwise procedure. 

In modifying milk the object is not to make it as 
near like human milk as possible but to make a cow's 

45 



46 THE CARE OF CHILDREN 

milk modification which a human infant can digest. 
The relation of human milk to cow's milk given in 
percentages is : 





Human 


Cow's 


Fat 


4% 


A°/o 


Proteid 


2% 


3-5 


Carbohydrates 


7% 


4-5 



From this it will be seen that the proteid in cow's 
milk is greater and the sugar or carbohydrates lower; 
the fat is usually considered about equal, although 
very frequently this has to be changed. 

A matter of great importance is the selection of the 
milk. There is such a vast difference in the quality 
and cleanliness of milk, it becomes the duty of every 
mother to know something of its source. Milk should 
by preference be purchased from a reputable dealer, 
selling from a tuberculin tested herd and an inspected 
dairy. In other words, it should be certified milk. 
There is for this, very properly, an extra charge. 
This cost is, however, more than compensated for by 
the assurance of its purity. When compared with the 
danger and cost of illness due to the use of unclean 
milk, it is not to be considered. Milk should always 
be bought in bottles. Dipped or bulk milk is unfit 
for use as an infant food, since it is most apt to con- 
tain bacteria in large numbers. If one lives in the 
country where conditions make it impossible to secure 
certified milk, one should endeavor to make arrange- 
ments to induce the producer to at least safeguard the 



MILK HYGIENE 47 

purity of that purchased for formula use. The nec- 
essary precautions are : — 

First. That the udders and teats should, before 
milking, be wiped off with a cloth, which is boiled 
daily, using plenty of warm water. Never wash 
teats with the milk. 

Second. Before milking, a clean duster should be 
slipped on and the hands well washed with soap 
and hot water. 

Third. The milk pail used should be well cleaned, 
scalded daily before use, and of the improved type, 
which means that it should be mostly covered, hav- 
ing only a small opening at the top. 

Fourth. The first few jets of milk should be 
thrown away and the milking should not be done 
where dust and dirt, as from a hayloft above, is 
sifting down upon the milker, and as must follow, 
into the milk. 

After the milk has been drawn, it should be 
strained through several thicknesses of clean cheese 
cloth (previously boiled), in which have been placed 
several layers of absorbent cotton, into quart bottles. 
The bottles should be placed at once in a pail of 
cracked ice in which it should be delivered. Those 
living in the country who control their own milk 
supply may easily carry out these precautions; those 
who do not must expect to pay to the producer con- 
siderable more for his diligence in safeguarding the 
milk. And are all these precautions warranted? 

When we consider that the vast majority of intes- 
tinal derangements in infants during the summer are 
caused by impure milk, we answer, Yes! a thousand 



43 THE CARE OF CHILDREN 

times. Milk, we must remember, is an ideal food for 
germs as well as babies. And if to begin with it is 
swarming with bacteria, what myriads it must contain 
by the time it reaches the baby. 

There is a very little to be gained by securing clean 
milk, if after delivery it is left standing in the sun or 
in the hot kitchen. The bottles of milk should at 
once be placed in the ice box, not in the part where 
food is kept, but in direct contact with the ice. The 
necessity for keeping the baby's milk in direct con- 
tact with the ice during the warm months cannot be 
too much emphasized. Milk always contains some 
bacteria, and if allowed to become warm and so remain 
for several hours, these bacteria multiply enormously. 
It is bacteria that cause milk to so quickly sour. 
And it is the poisons from the bacteria in the milk 
that produce so much bowel trouble in infants during 
the summer. 

The convenient articles for use in connection with 
preparing the formula are : — 

A double boiler for preparing cereal water 

As many graduated eight-ounce feeding bottles as 
there are feedings in twenty- four hours 

A new clean cork stopper for each bottle, or non- 
absorbent cotton 

A graduated measuring glass, holding not less than 
eight ounces 

One two quart pitcher for use in mixing formula 

One funnel 

One fork 

One tablespoon 



MILK HYGIENE 49 

One teaspoon 

One long-handled spoon for stirring 

Bottle brush 

Bottle rack to keep bottles upright in ice box 

A pail or kettle for use in sterilizing the utensils 
(and pasteurization) 

A nipple for each nursing bottle 

One thermometer for use in connection with pas- 
teurization if the food is to be pasteurized 

If the formula calls for cereal water, this should 
be made fresh every day and must of course, be pre- 
pared considerably in advance of the time needed. 
The methods of preparing cereal waters are : — 

Rice Water or Oatmeal Water: Two tablespoon- 
fuls of ordinary rice or oatmeal to one quart of 
water, cook three hours in a double boiler, adding 
water from time to time, that a quart may remain 
at the end of the boiling period. 

Barley Water: Two level tablespoonfuls of pre- 
pared barley flour, blended with a little cold water, 
and added stirring to a pint of boiling water con- 
taining a pinch of salt. Boil hard for 3-5 minutes, 
stirring constantly. Then cook for one hour in a 
double boiler. After straining add as much boiled 
water as has boiled away. 

Sometimes the baby's formula calls for lime water 
and in rare instances whey. 

Lime Water: To a quart of boiled water, add, 
after it has cooled, eight lime water tablets. Al- 
low this to stand over night, then strain and bottle. 

Whey: First, make junket. Heat one pint of 



50 THE CARE OF CHILDREN 

milk one hundred degrees F. Add one junket tab- 
let, previously dissolved in a little water, or two tea- 
spoonfuls of essence of pepsin. Allow this to stand 
until firmly jellied, then stir with a fork and strain 
off the whey. This must be heated again to ioo 
degrees F. then cooled, before milk can be added, 
else it will again make junket. 

After preparing the cereal water or other ingredi- 
ent, as called for in the formula, the next step is to 
boil 2-5 minutes the feeding bottles and all other 
articles to be used. Then pour off the water from the 
bottles and other utensils, put on a big washable apron, 
wash the hands thoroughly and you are ready to begin. 
After assembling on a clean table all the things you 
are going to need, take the milk bottle from the ice box, 
rinse it with cool boiled water and wipe the top with 
a clean towel or cotton. Next, with the fork which is 
among your implements, remove the paper cap. Then 
with your formula before you, giving the exact in- 
gredients for the number of feedings necessary for 
twenty- four hours, begin to mix them. 

First, measure the necessary amount of boiled 
water (or cereal water) as may be called for in form- 
ula, measuring with the graduate glass and emptying 
into the pitcher. Then measure the sugar (when 
milk sugar is used it must be dissolved in hot water) 
and if called for, the lime water, adding these to the 
ingredient in the pitcher, stirring well the mixture 
with the long handled spoon, which should be among 
your sterilized utensils. After adding to this mixture 



MILK HYGIENE 51 

the necessary amount of milk, take your feeding bot- 
tles and fill with the required number of ounces. 
The bottles should then be tightly corked with corks, 
rubber stoppers or wads of non-absorbent cotton (pref- 
erably corks boiled daily) and placed in the bottle 
rack for pasteurization. 

To pasteurize milk heat to 150 degrees F. and 
keep at this temperature for thirty minutes. There 
are various kinds of inexpensive pasteurizers on the 
market, but if unobtainable, pasteurization can be ac- 
complished by securing a wire bottle rack and placing 
this in a pan deep enough to allow the water to come 
to the same line as the milk in the bottles. Starting 
with cold water, watch the thermometer closely until 
it has reached 150 degrees F. then replace a small 
quantity of the hot water by cold water from time to 
time, being careful not to allow the cold water to 
come in contact with the hot bottles. When the milk 
has been kept at 150 degrees F. for thirty minutes, 
cool quickly by gradually replacing all the hot water 
with cold water. The milk should then be placed at 
once on the ice. 

Do not uncork the bottle from the time first closed 
until the baby is to be fed. 

The type of nursing bottle used is an important con- 
sideration. It must be so constructed as to be read- 
ily cleansed. A long neck bottle having a sharp 
angle below or one with corners on the inside should 
never be used, since to clean such a bottle is difficult 



52 THE CARE OF CHILDREN 

if not impossible. The eight ounce cylindrical bottle 
(rounded both at bottom and top) with the scale in 
ounces blown in the side is the best nursing bottle. 

Sometimes in writing a formula the quantity of 
milk used from bottled milk is spoken of by the 
physician in percentages of fat: 

Whole milk contains four per cent, fat 
The upper 24 ounces, five per cent, fat 
The upper 20 ounces, six per cent, fat 
The upper 16 ounces, seven per cent, fat 
The upper 10^ ounces ten per cent, fat 

When top milk is spoken of, use the first sixteen 
ounces. If the formula calls for whole milk, before 
using, shake the bottle well. 



CHAPTER VII 

HOW TO DECIDE ON THE FORMULA 

[This chapter was written by Charles Hendee Smith, M. D., 
New York City. 1 ] 

In the beginning it must be definitely understood 
that it is impossible to give directions for a formula 
which will be correct for every child. It is well nigh 
impossible to do this for any child because every baby 
differs in some respects from all others. The feeding 
of infants is a difficult subject, one which has been 
much studied by some of the ablest minds in the 
world, and yet one which is not entirely understood in 
all its phases even now. Every few years it is nec- 
essary to revise one's theories according to new facts 
brought out by scientific study. 

This is true even for the food of the average, 
healthy infant. For the one who is abnormal, or un- 
derweight, and especially for one with poor diges- 
tion, it is doubly true. 

Whenever possible the diet of a baby should be 
ordered by someone who really knows the principles 
of infant feeding. At present, physicians who have 

1 Professor of Clinical Diseases of Children in Columbia 
University; Visiting Physician, Bellevue Hospital, Children's 
Medical Division ; Consulting Physician, Infirmary for Women 
and Children and United Hospital, Portchester. 

53 



54 THE CARE OF CHILDREN 

devoted time to studying the subject, and who have 
had experience in the actual handling of feeding 
cases are the only safe advisers in this important mat- 
ter. 

Every mother should put herself under the guid- 
ance of such a physician as soon as possible after the 
baby's birth, for she needs advice while nursing just 
as much as she does when the baby must be bottle fed. 
The hours of nursing, the length of time at breast, 
whether one or both sides should be given, and many 
other matters cannot be decided by instinct. The diet, 
exercise, and hygiene of the mother should be directed. 
The time of adding one or more bottles, and the for- 
mula for them are important matters. Most of all, 
the question of weaning, when and how it should be 
done, ought not to be left to the mother or the neigh- 
bors. Many babies are weaned too soon on insufficient 
grounds. 

A very common mistake is to wean a baby who 
has indigestion, vomiting, colic or diarrhoea, with 
the idea that the milk is bad, when really he is merely 
getting too much of a very good milk. On the other 
hand, some babies are nursed weeks and months longer 
than they should be in a mistaken effort to avoid bot- 
tle feeding, when there is really no breast milk. 

The expense of consulting a physician occasionally 
for a baby who is well is much less in the end than that 
involved after an upset is brought on by amateur feed- 
ing methods. Furthermore, unwise experimenting 



THE FORMULA 



55 



may result in serious illness of the baby and perhaps 
even mean his loss. 

There are certain fundamental principles which may 
enable a mother to make up a formula if she cannot 
easily reach a physician who understands the subject. 
The method given here applies only to the normal, 
average, healthy baby. It will not work with the un- 
usual infant, nor when there is difficulty with the di- 
gestion. 

I. In the first place it is necessary to know what 
TOTAL VOLUME of liquid food a baby needs in 24 
hours. This may be determined by a very simple rule, 
depending on the weight of the child. 

In the early manths give about 3 ounces for each 

pound. 
In the middle months give about 2j4~2^2-2j4 ounces 

for each pound. 
Toward the end of the year give about 2 ounces 

for each pound. 



For example: — 
A baby of 7 lbs. needs 



3 . X 7 or about 21 oz. 



u a 


" 10 " 


tt 


*A X 10 " 


" 28 " 


a tt 


" 12 " 


tt 


23/2 X 12 . " 


" 30 " 


tt it 


" 15 " 


tt 


m x 15 " 


" 35 " 


tt <t 


" 18 " 


tt 


2*4 X 18 " 


" 40 


tt tt 


" 20 " 


tt 


2 x 20 " 


" 40 " 



Never give over 40 ounces a day. 

II. The second point is the NUMBER and HOURS 
of feedings. 

In the early months give 7 feedings. 



56 THE CARE OF CHILDREN 

At 6, 9, 12, 3, 6, io, and once in the night (1-3)- 

After 2-4 months give 6 feedings. 
At 6, 9, 12, 3, 6, 10. 

Or 6, 10, 2, 6, 10, and once in the night (1-3) 

After 3-5 months give 5 feedings. 
At 6, 10, 2, 6, 10. 

Some babies can be reduced to 6 or 5 feedings 
earlier than others. It is well to do this as soon as 
the baby will go without the larger number of feedings. 

III. The AMOUNT AT A FEEDING is found 
by dividing the total volume of food by the number 
of feedings. It is usually a little less than % ounce for 
each pound of the baby's weight. 

For example : — 

A 7 lb. baby takes 21 oz., 7 feeds, 3 oz. each 
" 10 " " " 28 " 7 4 " 
" 12 " " " 30 " 6 " 5 " " 

a I5 « « « 35 "5-7 " " 

An 18 " " " 40 " 5 " 8 " 

IV. The quantity of the formula having been de- 
termined, the next step is to decide on its quality. It 
must be made up of milk, water, and sugar or starch 
(flour). The AMOUNT OF MILK is found from 
the following rule. 

Give iyi to 1% ounces of milk for each pound the 
baby weighs. 

An 8 lb. baby needs 12-14 ounces of milk 
A 10 " " " 15-17^ " " " 

it I2 11 u tt i8-2I " " " 

« i6 « « « 24 _ 2 g 

it 20 tt ti tt ^ _ 32 tt it tt 



THE FORMULA 57 

Never give over 1 quart of milk. 

Do not give top milk or cream (unless it is es- 
pecially ordered by a physician) but shake the 
bottle well before pouring off the milk. 

V. The difference between the ounces of milk and 
the total volume is made up by adding WATER. 
Plain boiled water is sufficient at first. After the 
first 5 to 7 months, barley water may be used as a 
diluent. 

VI. In addition to the milk and diluent (water) it 
is advisable to add SUGAR in some form to each 
formula. 

About an ounce of sugar is needed for most for- 
mulas. At first it is safer to add J4 ounce, then in' 
crease in a few days to an ounce. If the baby does 
not gain and has good digestion, the sugar may be 
increased to iJ4-iH ounces. It is rarely, if ever, 
desirable to go above this amount. 

It is necessary to know something of the different 
sugars. The three which are commonly used in in- 
fant feeding are milk sugar, cane sugar, and dextri- 
maltose (a mixture of malt sugar and dextrin). 

Milk sugar is the natural sugar found in the milk, 
and so it would seem to be the logical one to use. 
It is expensive, however, and is no better borne 
than the others. 

Cane sugar is the sweetest and therefore may be 
taken best when bottles are first given. It is the 
cheapest sugar and is well borne by most babies. 






5 8 THE CARE OF CHILDREN 

Dextrimaltose may be given in somewhat larger 

amounts since it is only about one half sugar. 
The dextrin (which is a substance midway be- 
tween starch and sugar) is gradually converted 
into sugar in the body and so serves the same 
eventual purpose. Malt sugar may cause vom- 
iting in some babies, and should never be used 
when that tendency exists. For the same reason, 
it is best not to give it to very young infants. 
Dextrimaltose No. 3 contains 2% of carbonate of 
potash which makes it more laxative. This may 
be used when there is a tendency to constipation, 
otherwise No. 1 should be used. 

In general, then, it is perhaps best to start with 
Cane or Milk Sugar and later change to Dextrimal- 
tose, especially if it is necessary to increase the sugar 
above one ounce. 

There is one important difference in the sugars 
which must never be forgotten, that is that cane sugar 
is heavier, bulk for bulk. 

1 ounce of Cane Sugar contains 2 level tablespoonfuls 
" " " Milk Sugar 
" " " Dextrimaltose 

Barley Flour " 3 



U it it 



«« 


3 
3 


a 


u 


it 


n 


u 


tt 


a 


u 



Let us take one or two examples to illustrate the 
method described. 
(1) A baby of one month who weighs 8 .pounds: 

I. Volume of Food= (Weight x 3) 8 x 3 = 24 oz. 
II. Number of Feedings = 7 
III. Amount at Feeding = 24 = 3+ or (24 = 3^) 



THE FORMULA 59 

Take Volume as 245^ ounces ; 7 feeds of $ l /i ounces. 

IV. Milk (Weight x i^ to iji) =8 x i l / 2 = 12 oz. 
V. Water (24^ minus 12) = 12^ " 

VI. Sugar (%-i ounce) = Milk Sugar 2-3 Tbsp. 

or Cane Sugar 1^2-2 Tbsps. 

The formula then, Water 12^ ounces 

Milk Sugar ... 3 Tbsps. 
Milk 12 ounces 

24*^ ounces 

Feed 3^2 ounces every 3 hours — 7 feedings 
At 6, 9, 12, 3, 6, 10, and once in the night. 

If the baby does not gain, 1 or 2 ounces more milk 
may be added. Only ij4 ounces per pound were 
given since this is a young baby. 

(2) A baby of three months who weighs 12 lbs. 

1. Volume of food = ( Weight x 2^2 ) or 12 x 2% 30 ounces 

II. Number of feedings 6 

III. Amount at feeding 5 ounces 

IV. Milk = (Weight xi|4)or,i2x iM= 21 ounces 
V. Water = 30 minus 21 9 ounces 

VI. Sugar 1 ounce 

30 ounces 

Formula is Water 9 ounces 

Milk Sugar 

or 
Dextrimaltose .... 3 level Tbsps. 
Milk 21 ounces 

£ , .. 3° ounces 

feedings of 5 ounces 

At 6, 9, 12, 3, 6, 10. 

(3) A baby of seven months who weighs 16 lbs. 

I. Volume of food = (Weight x 2%) =36 (35) 

II. Number of feedings 5 

III. Amount at Feeding 7 (Take 35 

as Volume.) 



60 THE CARE OF CHILDREN 

IV. Milk = (Weight x 1 24) or i6xiK = 28 ounces 

V. Water (35 minus 28) 7 ounces 

VI. Sugar 1 ounce, Dextrimaltose .... 3 Tbsps. 

If no gain, increase sugar to 3,^ or 4 Tbsps. 
Or add Barley Flour — 1 Tbsp. (cooking 1 hour o* 
course) 

Formula is, Water 7 ounces 

Dextrimaltose . . . 3-4 Tbsps. 
Milk 28 ounces 

35 ounces 

The question as to the use of barley water or plain 
water puzzles many mothers. Barley flour is mostly 
starch, which is changed into sugar by the digestive 
processes. It can be digested even by the youngest 
babies, with rar'e exceptions, and may be used at any 
time to replace part of the sugar in the formula. It 
is not necessary to use it in the early months. After 
the 6th-7th month it is well to add 1 tablespoonful to 
the formula, especially when the baby does not gain 
on a formula containing 1 ounce of sugar. 

Thus in the last example given the formula could 
be made up as follows: 

Barley water 1 level tbsp. 

Water 7 ounces 

Boil hard for a few minutes and cook for an hour in 
double boiler. 

Add: 

Water up to 7 ounces (to replace water 

boiled away) 

Dextrimaltose 3 level tablespoonfuls 

Cool and Add: 

Milk 28 ounces 

5 feedings of 7 ounces ... =35 ounces 



THE FORMULA 61 

Note: The Barley Water should always be cooled 
before adding milk except when milk supply is so 
poor that it must be boiled for safety. 

Toward the end of the first year other foods should 
be given in addition to the formula. The latter is 
therefore not increased as much in proportion as the 
baby grows older, since some of the increased needs 
are met by the added foods. 

Orange Juice: i teaspoonful to 4 tablespoon fuls 
may be given after the first 3-5 months and should 
be given after the 6-7 months. 

Prune Juice, Prune Pulp, Apple Sauce, may be given 
at about 11-12 months. (Always cook fresh for 
one day at a time.) 

Cereal : May be added at any time after 6-8 months. 
Farina, Cream of Wheat, Wheatena, Oatmeal, (all 
cooked 3-4 hours and well strained) are the best 
to begin with. 

Give y 2 -i tablespoon ful at 10 o'clock 
Later 1-2 tablespoon fuls at 10 and 6 o'clock. 

Beef Juice : May be given with the 2 o'clock feed- 
ing at any time after 7 months. 1-3 tablespoon- 
fuls of juice squeezed from a freshly seared piece 
of round steak. 

Green Vegetables: (Spinach, peas, string beans, 
carrots) may be given after 9-10 months. 1 tea- 
spoonful, strained, and always freshly cooked, may 
be given alternating with the beef juice at the 2 
o'clock feeding. 

For example: 
A baby of 10 months weighing 18 lbs. 

I. Volume 2J4 x 18 = 40 ounces 

II. No. of Feedings = 5 



62 THE CARE OF CHILDREN 



III. 


Amount at Feeding 


= 8 ounces 


IV. 


Milk=Weightxi34 


= 32 ounces 


V. 


Water=40 minus 32 


= 8 ounces 


VI. 


Sugar-Dextrimaltose 


2-3 Tbsps. 




Barley Flour 


1 Tbsp. 




In addition at 9 o'clock 


Orange Juice 1 Tbsp. 




" 10 


Cereal 1 Tbsp. 




" 2 " 


Beef Juice 1 Tsp. 
or Green Vegetable 1 Tsp. 




« 6 


Cereal 1 Tsp. 



The above simple method is applicable only to nor- 
mal, average, healthy infants, it must be remembered. 
It will not apply to abnormal ones. When a baby 
is healthy but underweight for his age, it may be used 
as follows: 

Take an average between what the baby should 
weigh, and what he actually does weigh. Make up a 
formula for the weight corresponding to this average. 
This will do for a starting point. If the baby does 
not gain, increase slightly. Do not give as much as 
the baby would take if he were of average weight. 

For example: 

A baby of 6 months weighs 10 lbs. 

He should weigh about 16 lbs. 

Average 26-7-2= 13 lbs. 

Make up a formula as if baby weighed 13 lbs. In- 
crease if he does not gain. 

This will not be successful in all cases. Such 
babies need the care of a physician and should have 
it if one can be reached. 



THE FORMULA 63 

Directions cannot be given for feeding when there 
is acute or persistent difficulty with the digestion. 
There are certain fundamental principles which every 
mother should know, however, for a knowledge of 
them may save the baby a long illness and neglect of 
some of them may cost his life. 

(1) In case of any acute illness or fever cut down 
the food boldly. It never does any harm to omit one 
bottle, giving water, or to put the baby on barley 
water while waiting for the doctor. A full feeding 
given to a sick baby may cause a very serious ill- 
ness. 

(2) In a sudden diarrhoea (loose or watery stools) 
— stop milk, give only barley water until the trouble 
ceases. In beginning milk after the stools are nor- 
mal, add 1 ounce of boiled milk, gradually increas- 
ing to full amount in 5 or 6 days but no sugar until 
sure that diarrhoea will not return. Then add ^2-1 
tablespoon ful of sugar and slowly increase to full 
amount. Stop boiling milk when back on regular 
formula. 

(3) Sudden vomiting usually means the onset 
of a digestive disturbance. Stop formula and give 
only water or barley water until a doctor sees the 
baby. 

Persistent vomiting is due to many causes. A 
great many babies spit up a little occasionally. This 
is not true vomiting and no great importance need 
be attached to it. The simplest cause of true vom- 
iting is distension of the stomach by swallowed air. 
Holding the baby upright so that he can eructate 
"gas" after each feeding will often stop the vomiting. 
Too much at a feeding, too high fat (from the use 
of top milk or cream), too much sugar, (especially 
Dextrimaltose) may all cause vomiting. 



64 THE CARE OF CHILDREN 

If a baby vomits or spits up every day, after most 
of his feedings, and is not relieved by holding up to 
eructate, the milk may be skimmed. This is done 
by removing the top 6-8 ounces from the bottle with 
a Chapin dipper. The rest of the bottle or "bottom 
milk" is to be used. Since it has less fat and hence 
a lower food value than whole milk, it may be given 
in somewhat larger amounts — up to 2 ounces per 
pound of the baby's weight. 

A baby who has had top milk or cream and who 
begins to vomit should be put on skim milk mixture 
until he stops vomiting. 

It is also well to reduce the amount of sugar for 
a few days to one half to two thirds of an ounce. 

Violent vomiting of all food in a young infant is 
a symptom suggesting spasm or obstruction of the 
outlet of the stomach. A physician must be con- 
sulted at once. Vomiting may be a serious symptom 
in any case and must not be neglected. 

(4) Hunger indicates an increase in food. Hun- 
ger is not shown by crying after feeding, but by 
crying a long time before feeding time. A baby 
who is really hungry will not gain. If he has 
gained 4-6 ounces a week, it is evidence that he is 
getting enough food and the crying is due to some 
other cause than hunger. 

(5) Overfeeding is a common mistake and 
eventually will upset most babies. The baby shows 
an increasing tendency to vomit or has too many 
stools with curds or mucus ; or merely a failing ap- 
petite; or an eruption on the face (eczema). These 
symptoms come in almost any order, and if preceded 
by a rapid gain, 7-8 ounces or more in a week, over- 
feeding must be suspected. If the overfeeding is 
continued, all the symptoms become worse, and the 
baby may become very ill. Mothers are apt to want 
too large a gain. A baby who gains 4, 5 or 6 ounces 



THE FORMULA 65 

a week is gaining enough. A half pound a week is a 
large gain and anything over that amount may be too 
much. The food should never be increased when 
there has been a sufficient gain. It is not necessary 
to increase the strength or amount of the food more 
than once in two weeks in the majority of cases. 



CHAPTER VIII 

HOW TO GIVE THE BOTTLE 

There is some misconception as to the proper 
way to give the bottle to a baby. 

In giving the bottle there are four things against 
which to guard: — 

First. Giving the feeding too cold or too hot. 

Second. Contamination. 

Third To avoid feeding either too slowly or too 

rapidly. 
Fourth. To prevent the baby from swallowing air. 

A few minutes before feeding time take the bottle 
from the ice box, leave it corked, and place in a pan 
of slightly warmed water. The vessel should be deep 
enough to allow the water to cover the bottle above 
the milk line. Place the pan over a low fire and 
allow the water to heat but not to boil. To test the 
temperature of the milk. Place the bottle, after it 
has been wiped dry, against the cheek or remove the 
stopper and pour a few drops of milk on the inner 
surface of the arm. In either instance, if it feels com- 
fortably warm to the skin, it will be right for the baby. 
If the milk has gotten too hot, cool by placing the 
bottle under running water. 

Never test the temperature of the milk by putting 

66 



HOW TO GIVE THE BOTTLE 67 

the mouth of the bottle or the nipple to the mouth, as 
in this way there may readily be conveyed to the child 
disease germs. 

Before adjusting the nipple on the bottle, wash the 
hands thoroughly. If possible, do this under running 
water. Handle the nipple only by the neck and do not 
allow the hands to come in contact with the part which 
goes into the baby's mouth. Never use the kind of 
nipple which requires to be attached to a long rubber 
tube. To keep this clean is absolutely impossible and 
it therefore becomes a menace. The conical type of 
nipple is best, since to be cleaned it can readily be 
turned inside out. 

The nipple must have 2 to 3 good holes so that the 
milk will drop freely (without shaking the bottle) 
when the bottle is held wrong side up. If the holes 
are not large enough, stick a needle in a cork, heat 
to red heat and pass through the nipple to make good 
holes. Boil afterwards to remove taste of burned 
rubber. Be sure that the baby can get the milk easily. 
He should finish the bottle in 7-10 or 12 minutes. It 
is not necessary nor advisable for him to take 20 
minutes. If he cannot get milk freely from the bottle, 
he will swallow more air and be uncomfortable or 
vomit. 

Before giving the bottle, it is a good plan to hold 
the child in an upright posture. For in this position, 
if there is any gas in the stomach, it is allowed to es- 
cape. 



68 THE CARE OF CHILDREN 

When giving the feeding, the baby should be placed 
in a semi-erect position. And why? 

There is a real scientific reason. In the upright 
position, food when entering the stomach gravitates 
to the lowest point. This causes a displacement of 
any gas that may be present, to the highest point 
of the stomach. And what is the significance of 
this? 

Simply that it makes possible the escape of the gas 
by mouth. This frequently happens at once in the 
form of an eructation. 

When a baby is fed while lying in a horizontal 
position, a water lock is formed and the eructation 
of gas is prevented. What happens? 

Since the gas cannot escape by mouth, it must nec- 
essarily pass through the intestines. This causes dis- 
tension which is both painful and unfavorable to gas- 
tric secretion. Thus the horizontal posture by pre- 
venting eructation of swallowed air, is a frequent 
cause of vomiting, colic and disturbed sleep. 

The correct way to feed an infant is to take him 
on the left arm, holding in the same position as for 
breast feeding. In presenting the bottle hold at an 
angle which will keep its neck continuously filled. 
The baby should be allowed to grasp the nipple 
squarely in the mouth. The feeding should always 
be finished within fifteen minutes. Slow feeding only 
multiplies the number of swallowing acts and there- 
fore increases the amount of air taken into the 



HOW TO GIVE THE BOTTLE 69 

stomach. If the baby is sleepy, keep him awake until 
the bottle is finished. Never allow the child to sleep 
for a little while then take the bottle again. This un- 
duly prolongs the feeding and interferes with diges- 
tion. On the other hand, if the bottle is taken too 
greedily, several times during the feeding, withdraw 
the nipple for a moment. 

Immediately after the feeding, the baby should be 
held against the shoulder of the mother or nurse. 
He may be gently patted on the back to encourage 
the eructation of any air that may have been swal- 
lowed. After such eructation place the child at once 
in a horizontal position with a small soft pillow under 
the head and allow him to sleep. 

After the baby has been placed in bed, the nursing 
bottle which has just been emptied, to prevent any 
milk souring in it, should be rinsed with cold water, 
refilled with water (adding a pinch of bicarbonate of 
soda) and left standing, until the bottles for one day's 
feeding have all been used. At the end of this time 
or when convenient, place the bottles in hot soap suds 
and scrub thoroughly using a bottle brush on every 
part of the inside of each bottle. After rinsing 
through several waters, they should be put on the fire 
in a kettle of cold water and allowed to boil for fifteen 
minutes. After they have cooled, place in cool boiled 
water in a covered receptacle until needed. The bottles 
are then sterile and ready for use. 

The nipple after use should be rinsed with cold 



70 THE CARE OF CHILDREN 

or luke warm water and rubbed with a little common 
salt in order to remove the milk. 

It should then be turned inside out and given the 
same treatment. 

After being sterilized (boil once a day) they may 
be kept in a weak solution of boracic acid, or borax 
(y 2 teaspoonful to glass of water) in a vessel securely 
covered. A fresh nipple should be used for each 
feeding. Extra nipples should be prepared, since they 
are subject to many accidents. Infants should never 
be allowed to suck on a rubber nipple or pacifier. 
Aside from the air swallowed, there is the constant 
danger of infection from this source. Also, the con- 
stant sucking causes an enlargement of the soft tissues 
at the base of the nostrils and the formation of a 
spongy growth. This growth is known as adenoids; 
it blocks the nostrils causing respiratory disability and 
can only be removed by surgical interference. A cele- 
brated throat specialist has said that two-thirds of the 
cases of adenoids that came to him were caused by 
children having a pacifier or having been allowed to 
suck their thumbs in infancy. 



CHAPTER IX 

WEIGHING THE BABY 

The average baby girl weighs seven pounds at birth, 
while boys usually tip the scales at seven and a half 
pounds. 

While a healthy baby may weigh as little as five or 
six pounds and as much as ten or twelve, these 
weights are unusual. 

During the first three or four days or even the 
first week while the mother's milk is being established, 
the baby may lose as little as one or two ounces or 
even as much as seven or eight ounces, but this loss 
is usually regained in from four to ten days, and from 
that time there should be a gradual gain. 

The daily gain during the first month should aver- 
age about three-quarters of an ounce. He should 
then average from four to eight ounces a week up to 
the sixth month. From the sixth to the twelfth month 
usually the weekly gain is from two to four ounces. 
In other words, the average baby usually gains from 
one and a quarter to one and a half pounds a month 
for the first six months ; from the sixth month to the 
first year, about one pound a month. That is, at the 
end of five or six months he has doubled his birth 

7i 



72 THE CARE OF CHILDREN 

weight and by the end of the first year has trebled 
it. 

As the weight is the best index of a baby's nutri- 
tion, he should be weighed at regular intervals. 
During the first weeks of life he should be weighed 
daily, and up to six months of age once a week. After 
six months once in two weeks is sufficient. 

The ordinary platform balance scales with a special 
basket are the best for weighing a baby. Spring scales 
are seldom accurate, because of the difficulty in pre- 
venting the baby from moving. To weigh the baby: 

Put a soft cloth in the basket of the scales and after 
undressing the baby completely, lay him on it, weigh 
carefully and mark down the result. The weight of 
the cloth must of course be deducted. If the room 
is not sufficiently warm, the baby should be wrapped 
in a blanket and weighed, afterward deducting the 
weight of the blanket. 

Always keep a written record of the baby's weight 
from day to day and week to week, for it is impossible 
for one to carry this in the mind accurately, and the 
records should be kept for comparison. 

A very rapid increase in weight is not the goal for 
which the mother, should strive. The ideal is to have 
the baby weigh enough, but not too much; in other 
words, a duly proportioned or symmetrical develop- 
ment of all parts of the body. 

The baby too fat is no more to be desired than the 
one too thin. For a baby who gains excessively, be- 



WEIGHING THE BABY 73 

coming very fat, is more often than not pale, with 
flesh too soft and muscles flabby and has not the life 
and alertness of the well-nourished and all-round well- 
developed baby. Such a baby is generally one fed on 
an exclusive diet of some well-advertised proprietary 
infant food, which, consisting to a great extent of 
sugar or starch, easily produces fat, but does not con- 
tain all the constituents necessary to proper develop- 
ment of bone, blood, muscle, nerve and tissue. 

Usually the first indication to the mother that the 
baby she thought so fat and rosy has not been fed 
properly comes with his late development and some- 
times weakness and deficiency of health. He does 
not develop normally as to cutting teeth, sitting alone 
or walking. He does not have as much resistance 
to the diseases of infancy and childhood as the well- 
nourished, alert, wide-awake baby who is full of life 
and motion. 

On the other hand, if the baby is too thin — that 
is, much below his normal weight (unless he is just 
recovering from an illness) — he is usually fretful, 
seldom sleeps well and is apparently hungry most of 
the time. The chances are in a case like this that 
the child is getting sufficient food in quantity, but it 
is not the kind of food which he can assimilate; there- 
fore he is poorly nourished. 

The idea in baby feeding is to produce the happy- 
medium baby — that is, the one who weighs neither 
too much nor too little, but is well nourished and well 



74 THE CARE OF CHILDREN 

developed. This is best accomplished by giving a 
baby its natural food, the milk of a healthy mother. 
If this can not be obtained, then a correctly modified 
cow's milk is best. This should always be modified 
under the directions of a physician. Bottle-fed babies 
particularly need to be carefully watched as to their 
weight in summer. However, whether your baby is 
breast or bottle fed, if he does not make some gain 
week by week he is not being nourished properly. By 
all means see a physician. 

While all babies are expected to make a steady gain, 
there are times when a child may make little or no gain. 
This often happens in the summer during periods of 
excessive heat when his food has been reduced or when 
there have been some slight digestive disturbances. 
This should occasion no worry, as it is far better to 
have little or no gain, or even a little loss in weight, 
than to upset his digestion by overfeeding in order to 
keep him gaining. 

A standstill like this should, however, be temporary ; 
and when conditions; have returned to normal he 
should again begin to gain. A diminishing weight 
under normal conditions demands careful attention 
and the advice of a good physician. 

Many mothers think if they have weighed the baby 
regularly until one year of age they have discharged 
their final duty in that respect. This is a mistake. 
A child should be weighed once or twice a week until 



WEIGHING THE BABY 75 

eighteen months of age and once a month until six 
years of age. 

In determining the weight of older children, the 
height should also be taken into consideration. 

The maximum permissible deviation in weight from 
the normal in older children should not be greater 
than ten per cent. When the deviation exceeds this 
the child should be placed under the care of a physician. 

(For table of Average "Weights and Heights" see 
page 202, Chapter XXV, "Malnutrition and The 

Child."), 



CHAPTER X 

PROPER HABITS OF SLEEP 

Proper habits of sleep is a subject seldom given 
sufficient consideration by those caring for young chil- 
dren, and yet there is no habit formed which is of 
greater importance to the child. 

A new born baby should for the first month sleep 
nearly all the time, that is, about twenty-two hours 
out of twenty-four. And throughout the second and 
third month from twenty to twenty-two hours. Dur- 
ing the remaining three months of the first half year, 
he should sleep from sixteen to eighteen hours and 
up to the first year fourteen to fifteen hours out of 
every twenty- four. 

At six months of age the day-time sleep should con- 
sist of a two hour nap during both the morning and 
afternoon. And in order that the baby may be pre- 
pared for the long unbroken period of rest at night, it 
is best to have the afternoon nap come before three 
o'clock. After the first year of age one hour in the 
morning and two hours in the afternoon will be suf- 
ficient. These periods of sleep should then be con- 
tinued until the eighteenth month, after which time 
the morning nap may be given up. The afternoon 

76 



PROPER HABITS OF SLEEP 77 

rest of two hours, should, however, be continued until 
the end of the second year. And from this time until 
the child is six years of age he should sleep from one 
to one and a half hours during the afternoon. 

There is a very good reason why these sleeping 
hours should not be shortened. And this reason is 
the enormous growth of the brain. During the first 
year of the child's life the brain increases in size two 
and one-half times what it was at birth. This is a 
much greater growth than takes place during all the 
remaining years of life. Now, considering this fact 
alone, it can readily be seen how curtailment of the 
hours of sleep will cause a nervous, fretful baby. 

Sleep is regulated largely by habit. This being true, 
it is most important for the welfare of the baby, as 
well as the comfort of the entire household, that from 
the beginning proper habits should be established. 
Now, in order to establish proper habits, one must 
first fix in the mind of what they consist. They con- 
stitute feeding, bathing and doing all things that per- 
tain to the care of a baby, at a regular and definite 
time. If the correct routine is inaugurated at first, 
that is, if suitable feedings are given at definite times, 
followed by proper periods of sleep, little, if any, 
trouble will be experienced with sleeplessness. Sleep 
disturbances always mean at least one of four things : — 
Unsuitable food, bad habits, indigestion or illness of 
some character. 

Most physicians agree that the three-hour nursing 



78 THE CARE OF CHILD.REN 

interval is best for the baby until he is six months old 
and after this four hours may be allowed to elapse 
between feedings. 

If well trained, a healthy baby will usually awaken 
about every three hours. The feeding intervals should 
be arranged so as to agree with the waking periods. 
But should the baby be asleep when the feeding period 
comes around he should be gently awakened and given 
his feeding. If, however, he should awaken at other 
than his feeding hour, do not under any circumstances 
give him his feeding because he happens to be crying. 
Investigate the cause. He may be too warm, too 
cold, or he may be in a cramped position. See if the 
diaper is dry, if the band or diaper is too tight and if 
his feet are warm. Then turn the baby and give him 
a drink of sterile water, slightly warmed. If after 
doing all those things he still continues to cry, leave 
him alone. He will soon discover that nothing is to 
be gained by crying and will go to sleep again. He 
will also have learned a little lesson in discipline. 

An infant should never be allowed to go to sleep 
while nursing, neither should he be allowed to sleep on 
the mother's breast, nor with the nipple of the bottle 
in his mouth. From the beginning he should become 
accustomed to being put down while awake and go to 
sleep of his own accord. He should not be walked, 
rocked or dangled, neither should he be allowed to 
suck a rubber nipple or anything else. Not only are 
all of these methods of inducing sleep injurious, but 



PROPER HABITS OF SLEEP 79 

the baby will soon acquire the habit of not sleeping 
without them and will demand them with the full ex- 
tent of his lung power. All that is necessary to in- 
duce sleep in the healthy baby is a satisfied appetite, 
a warm bed, a clean body, a dry napkin, and a gentle 
current of fresh air passing through the room. While 
the room should be moderately quiet, it should not be 
necessary to walk on tiptoe or to talk in whispers be- 
cause the baby is asleep, as he will soon learn to sleep 
through ordinary household noises. During a long 
nap he should always be turned at least once. 

A baby should always be trained so the longest 
period of unbroken sleep will come at night. And 
with this idea in view, he should not be fed as fre- 
quently during the night. Make the interval four 
hours beginning with the 6 p. m. feeding. That is, 
after being put to bed at 6 p. m. he should sleep until 
10 p. M. when he should be given his feeding, even if 
it is necessary to awaken him. After this he should 
sleep until 2 a. m. and from then until 6 a.m. This 
will give three long periods of unbroken sleep. It 
will seldom be found necessary to give a feeding be- 
tween 10 p. m. and 6 a. m. after the baby is four 
months old. Any healthy baby can easily go this 
length of time and the prolonged period of sleep will 
be much better for him than food. In the beginning, 
when breaking away from the night feeding, if the 
baby is wakeful, give him a few swallows of boiled 
and slightly warmed water from a nursing bottle. He 



80 THE CARE OF CHILDREN 

will soon learn to be content without the night feeding. 

A baby should never be permitted to sleep in the 
same bed with the mother. From the beginning he 
should be provided with his own bed and whenever 
practicable, an entire room should be given over to him. 
This would then leave the question of heat, light and 
ventilation to be adjusted to his particular needs. 

For the first three months the temperature of the 
baby's sleeping room should be about 65 degrees. But 
after this time it may be permitted to fall to 55 degrees. 
And after the first year 45 degrees is not too cold. 

It is perfectly safe for a baby over a month old to 
sleep on a screened porch, in the summer, either night 
or day, provided of course, he is protected against 
sudden changes in the weather. Fresh air is a great 
sleep inducer and has a great sedative and soothing 
effect. Very often the fretful child is simply a victim 
of bad air. It is important to remember that the 
heat production in a child is very active and his need 
for oxygen much greater than the adult. Proper 
ventilation of a room is best secured by opening the 
windows from the top with cross ventilation. 

Whenever possible, that is, in good weather, the 
child should sleep out-of-doors an hour or two each 
day, care being taken always to protect the eyes from 
strong light. 

An important cause for disturbed sleep and restless- 
ness in a young child is over stimulation during his 
waking hours. The baby who is brought out in the 



PROPER HABITS OF SLEEP 81 

evening to exhibit his cunningness or precocity to 
visitors or who is tickled, played with, tossed about 
from one to another with bright lights shining in his 
eyes, has his little brain brought to a fine state of ex- 
citement and hence does not readily compose himself 
to sleep thereafter. Much of the play to which babies 
are subjected is harmful, as they need quiet and rest. 
But particularly does this apply to playing with the 
child in the evening when he should be asleep. The 
possibilities are that this will upset his regular habits 
and result in some nervous disturbance. 

When the baby is put to bed, see that the diaper is 
dry, that chafed spots (if any) are carefully cared 
for, that the sheets are free from wrinkles and that 
his hands and feet are warm. Care should be exer- 
cised not to tuck the bed clothing in too tightly. It 
is best to lay it over rather loosely, pinning it down 
around the bed with large safety pins. 

During the summer months, when the baby is rest- 
less and sleeps poorly, a warm bath given at bed time, 
will aid materially in promoting quiet, restful sleep. 

All children under six years of age should be put to 
bed not later than seven o'clock and should sleep until 
seven the next morning. 

Never give an infant or young child any kind of 
soothing syrup to induce sleep; they all contain drugs 
that are exceedingly injurious to young children. 

We are giving below a routine which, with some 
variations may be followed in the first year: — 



82 THE CARE OF CHILD.REN 

Morning 

6 a.m. Feeding 

7 a. M. (About 4th month) place on a small bowl 

or infant's chamber for bowel movement. 
The chamber should be held on the mother's 
lap with the baby's back well supported. 

8 A. M. Bath 

9 a. m. Feeding 

9.30 to 11.30 Place outdoors to sleep 

11.30 Exercise and play on bed 
12 noon Feeding 

Afternoon 

1 to 3 Outdoors to sleep 

3 p. m. Feeding 

4 p. m. Play and exercise. Should be taken up 

and held by mother for a part of the time. 

5 P. M. Undress and put on night clothing. Give 

sponge bath, if in Summer. 

Night 

6 p.m. Feeding 
6. 1 5 Sleep 

10 p. M. Feeding and diaper changed 

2 a. m Feeding (until 4th month)' and diaper 

changed 
2 a. m. to 6 a. m. Sleep 



CHAPTER XI 

baby's care in hot weather 

In order that a baby may be kept well and happy 
during the summer months, he should receive espe- 
cial care. And this care should be based on three 
main principles: — 

First. Guard against infection, from all sources, 
but especially through food. 

Second. Decrease the heat production by giving 
less food and more water. 

Third. Increase heat elimination by less and 
more porous clothing, better circulation of air and 
more frequent baths. 

The most important measure in the care of a baby 
during the summer months is proper food. And by 
proper food we mean not only that which is fitted to 
the baby's digestion but food as free from contamina- 
tion as you can make it. 

If the baby is breast fed, the feeding problem is, 
of course, quite simple, for not only is the danger of 
contamination reduced to a minimum, but nature, 
mindful of the fact that during very hot weather there 
is a partial intolerance for food, tends to regulate the 
quantity and quality of mother's milk. It is for these 

83 



84 THE CARE OF CHILDREN 

reasons that diarrhceal diseases are not common 
among nursing babies. If, however, the baby is bottle 
fed, the summer feeding problem becomes much more 
difficult. 

While the three c's of milk care — clean, covered and 
cold — are important at all times, they are particularly 
so during the warmer months. 

Pasteurization is absolutely necessary during the 
summer months, unless one is sure beyond a doubt 
as to the milk supply, which would mean the breed of 
cattle from which obtained, cleanliness of the milker, 
the utensils and all other things that contaminate 
milk. 

Before mixing the formula, all utensils to be used 
in connection with the work should be boiled. The 
hands should be thoroughly washed before preparing 
the milk and before handling either the bottles or nip- 
ples. The milk bottle should not, even for a minute, 
be allowed to remain off the ice. 

While the baby may get the germs of disease in 
ways other than through his food, they usually enter 
by way of the mouth. For this reason, everything 
that is not thoroughly clean should be kept out of his 
mouth. Such things as pacifiers or comforters are 
an abomination and should never be used. 

The baby should not be allowed to crawl around 
on the floor (unless on a space covered by a clean sheet 
or blanket) where he may come in contact with all 
kinds of germs. 



BABY'S CARE IN HOT WEATHER 85 

Flies are carriers of disease. In fact many cases 
of summer diarrhoea are directly traceable to germs 
carried by these insects. Flies should not, therefore, 
be allowed to come near the babies. The only way to 
avoid them is to screen the windows and doors and 
keep all containers of waste food material covered. 
The surroundings of the home should be free from un- 
covered garbage, manure or rubbish of any kind. 
Such things attract not only flies but other insects 
that carry disease. Always there should be a covered 
pail for soiled diapers, for should flies be allowed to 
come in contact with these, they may go from them 
directly to the baby or to his food. The baby should 
not under any condition be given anything to eat that 
a fly has touched. There is only one way to avoid this. 
Simply to make it a cardinal rule to place food where 
flies cannot come in contact with it. While all rooms 
should be screened against flies in summer, if this is 
not possible, by all means screen the baby's room. 

As a protection against mosquitoes, which not only 
prevent the baby from receiving proper rest but may 
also carry disease, the carriage, hammock or bed, when 
indoors or out, should be protected by netting so ad- 
justed as to prevent mosquitoes from crawling through 
while not interfering with the free passage of air. 

During hot weather not only is there a lessened 
desire and need for food but the digestive power is 
lowered. For this reason particular care must be ex- 
ercised to avoid overfeeding. For if more food is 



86 THE CARE OF CHILDREN 

given than the baby can digest, fermentation is allowed 
to take place. Poisons are then generated and ab- 
sorbed. These bring about fever and prostration. 
The resulting diarrhoea is Nature's effort to rid the 
intestine of the offending material. 

If the breast-fed baby should show tendency to 
vomit or to colic, the breast should be given every 
four hours instead of every three, and frequently be- 
tween nursings cool (not cold) boiled water should 
be given. 

For a bottle-fed baby the food should in warm 
weather be reduced by about one quarter to one third 
the ordinary amount. This does not necessarily mean 
that the quantity must be reduced. Simply reduce 
the strength of the formula by adding less milk, mak- 
ing up the difference with boiled water or some kind 
of cereal water. Give cool boiled water frequently 
between the feedings. Regularity in feeding, while 
important at all times, is particularly so in warm 
weather. 

The gain in weight is necessarily less in summer 
than under the more favorable conditions of cooler 
weather. In fact, some perfectly well children do not 
gain during the extremely hot weather. There should, 
however, be no loss of weight. 

The condition of the bowels is very important. 
While summer diarrhoea may first be signalled by an 
increased number of evacuations with griping pains 
in the abdomen, causing the baby to be fretful and 



BABY'S CARE IN HOT WEATHER 87 

restless, it may also come on quite suddenly, making 
itself known by vomiting, fever, griping pains and 
frequent evacuations. Even a slight attack should 
prompt the mother to send for the physician. And 
pending his arrival, all food with the exception of 
boiled water should be withheld. And as the intestine 
must as much as possible be relieved of the offending 
material producing the trouble, the baby should be 
given two teaspoonfuls of castor oil. These pre- 
cautionary measures are particularly important. For 
proper treatment at the beginning may be the means 
of avoiding a very serious illness. After even a slight 
attack of diarrhoea or any digestive disturbance, the 
baby's digestive ability is below normal. Thus the 
return to food must be gradual, especial care being 
exercised for at least ten days or two weeks. For 
since one attack of diarrhoea predisposes to another, a 
second attack with very little cause may occur. 

Measures for keeping the baby cool and comfortable 
are important precautions in summer care. First, it 
must be remembered that infants feel the heat much 
more than adults. Many babies are made uncomfor- 
able by an excess of clothing. Do not be afraid to 
take off the baby's clothes. The fewer the better dur- 
ing the hot months. The summer clothing should be 
loose, light and soft. When in the house, a slip and a 
light knitted band, in addition to the napkin, may be all 
that is necessary. And on excessively hot days one 
may dispense with the slip. If, however, the temper- 



88 THE CARE OF CHILDREN 

ature should drop as when a storm comes up, or 
towards nightfall, the baby must of course, be dressed 
in such a way as to protect from chill. 

In warm weather only the thinnest cotton clothing 
should touch the baby's skin. In general, neither 
wool nor starch should be allowed in the baby's cloth- 
ing in summer. 

The diaper should be made of cotton cloth, never 
of any kind of flannel. The cotton cloth washes 
easily and is less irritating to the skin. Flannel gets 
hard and rough after washing and will keep the baby 
hot and make him sore. 

If more than a month old, do not think of worry- 
ing the baby with a flannel band in summer. A band 
is very apt to twist and get out of place making him 
very uncomfortable. After the cord has dropped off 
all that is necessary is a light knitted band with shoul- 
der straps. At night take off everything that the 
baby has worn during the day, put on a fresh band 
and diaper and a soft roomy night slip. 

In washing the diapers use soap containing no free 
alkali and be sure they are thoroughly rinsed. Every 
diaper once used, no matter if only slightly dampened, 
should be washed before using a second time. After 
proper washing the diapers should be dried out of 
doors. 

In hot weather, since an infant needs to conserve 
all his energy, quiet and plenty of sleep are particularly 
essential. For if entertained and excited, he is much 



BABY'S CARE IN HOT WEATHER 89 

more liable to digestive disturbance than if quiet is 
imposed. 

During the summer the baby should be bathed at 
least twice a day. In the morning he should have his 
usual cleansing bath and at bed time should be given 
a bath just a little cooler. 

When the skin is inflamed or chafed or when the 
baby suffers from prickly heat, he should be frequently 
bathed in cool water but soap should not be used on 
the inflamed skin. A starch, bran or soda bath is 
often used in such cases, resulting in much relief and 
comfort. 

For the Starch Bath: Just use a cupful of ordinary 
cooked starch, without adding anything to it, to a 
gallon of water. 

For the Bran Bath: Put a cup of bran meal in a 
cheese-cloth bag, tie the bag at the top and stir this 
in the bath water until the water takes a milky hue. 

For the Soda Bath: Just dissolve two tablespoon- 
fuls of ordinary baking soda in some water and add 
it to four quarts of water. 

Fresh air is particularly essential during warm 
weather. Do not keep the baby in the house unless it 
is cooler indoors than out. Take him out on the porch, 
under a tree or into the park, but do not keep him shut 
up in the house. At the same time avoid exposure to 
the sun. Always see that the baby's eyes and head are 
shielded from direct sunlight. This is just as impor- 
tant when he is asleep as when awake. 



CHAPTER XII 

CONSTIPATION OF INFANTS AND CHILDREN 

Constipation is one of the most common disorders 
of the human family. It is found in each year of 
life from early infancy to old age. Among infants 
and children constipation is a prevalent and trouble- 
some derangement, having a far reaching effect. Its 
causes are many and varied. They are by physicians 
divided into two groups : — 

Predisposing and direct causes. 

Among the predisposing causes thought to have a 
bearing are : 

First. That the intestinal walls since they are 
less muscular than those of the adult, have less 
power to contract and expel the contents. In other 
words, that peculiar worm-like motion of the intes- 
tines (produced by contraction of its muscular 
fibers) which pushes the contents of the intes- 
tines onward, is less active in children than in 
adults. 

Second. The pelvis or hip bones, since they have 

not obtained the adult breadth, form a basin with a 

relatively smaller capacity. And in comparison 

with this the bowel is about one-third larger pro- 

90 



CONSTIPATION OF CHILDREN 91 

portionately. This means that the bowel must fold 
upon itself. Thus in place of one sack or pouch 
as in the adult, there is in the large intestine of in- 
fants and children, numerous loops or curves. 
These naturally render the passage of the intestinal 
contents less free. 

Third. Other factors considered no less import- 
ant by many are that the digestive juices, especially 
bile, are proportionately less in the child and that 
nerve power is necessarily deficient, since the sym- 
pathetic nervous system is undeveloped. 

These predisposing causes are influences beyond our 
control. We mention them merely to show that 
anatomically infants and young children are more 
liable than adults to constipation. 

The direct causes are the ones with which we are 
concerned. These are: — 

Errors in diet 

Deficient intake of fluids 

Irregularity of habit 

Improper posture when putting children to stool 

Some abnormal condition about the rectum. 

While it is sometimes difficult to determine in a 
given case the reasons for constipation, it is usually 
found that among bottle-fed babies the chief causes 
are: — 

First. Too much proteid (the curd or casein). 
This is the element in cow's milk forming the prin- 
cipal part of cheese. 

Second. Too low a percentage of fat. 



92 THE CARE OF CHILDREN 

Both of these causes may be removed by determin- 
ing in each case the proportions of fat and proteid 
suited to the digestion. This is a problem always to be 
placed in the hands of a competent physician. Other 
errors in feeding that may have a bearing on consti- 
pation among the bottle-fed babies are : — 

Too little sugar, insufficient quantity (causing scanty 
stools) and the use of boiled milk. 

If cutting down the proteid and raising the per- 
centage of fat does not correct the trouble or if it is 
impracticable to reduce the proteid, many physicians 
replace part of the sugar by maltose (a laxative), or 
they give one feeding daily of malted milk, to replace 
the customary feeding. Some, in preparation of the 
formula, use in place of boiled water, oatmeal water, 
which is laxative. Orange juice is of great value in 
helping to relieve constipation. It may be given as 
early as the beginning of the fourth month. Begin by 
giving one teaspoonful daily, strained and diluted with 
a little water. This may, a little later, be increased 
to a teaspoonful twice daily between feedings. Then, 
when well taken it may be gradually increased until at 
six months the child is taking four teaspoonfuls twice 
daily and at one year one ounce twice daily. 

If after regulating the formula and giving orange 
juice, constipation still persists, some physicians ad- 
vise fifteen to thirty drops of pure cod liver oil three 
or four times a day or a teaspoonful of sweet oil two 
or three times daily. 



CONSTIPATION OF CHILDREN 93 

When the breast fed baby is constipated, it is most 
often because the baby is responding to this condition 
in the mother or because the mother is not paying 
sufficient attention to diet and exercise. The first 
consideration of the mother should then be to look 
carefully after her own regime. She should eat fresh 
meat and an abundance of fruit and fresh vegetables, 
taking very little tea or coffee, but milk, cocoa, 
creamed soups and much water. Daily exercise is also 
a most important factor. At least three hours daily 
should be spent in the open air. If after the mother 
has carefully and faithfully regulated her bowels and 
her daily life, constipation in the breast-fed baby still 
persists, a little cream (from one to two teaspoonfuls) 
taken from the top of the best obtainable milk, diluted 
with an equal amount of quite warm water, given 
just before nursing, will by supplying the fat often 
aid greatly. If, however, this does not agree with the 
baby or is not efficacious, fifteen to thirty drops of 
pure cod liver oil may be given three or four times 
daily or a teaspoonful of sweet oil, two or three times 
daily. 

The errors in diet causing constipation in "run- 
about" children are usually : — 

First. Too much milk to the exclusion of other 
foods. 

Second. That the child has not learned to like 
vegetables or has not been given the coarser cereals 
and breads. 



94 THE CARE OF CHILDREN 

Third. Sufficient fruit has not been added to the 

diet. 

The diet of a constipated "run-about" should in ad- 
dition to oatmeal, hominy, corn-meal mush, green vege- 
tables, rare meats and coarse breads, take in much 
fruit. Stewed fruits should be given at meal time and 
raw ripe fruit freely between meals. 

At all ages one of the body's greatest necessities is 
that sufficient liquid be supplied. This is necessary 
that by the skin, kidneys, respiration and bowels, nor- 
mal elimination may take place. AH too often in- 
fants and sometimes "run-abouts' ' are given prac- 
tically no fluid except milk. And how does lack of 
sufficient fluid in the system have a bearing on consti- 
pation ? 

In children, especially when there is muscular weak- 
ness of the intestinal walls, the contents of the bowels 
are moved forward very slowly. During this leisurely 
process, the fluid portions be'come absorbed. And as 
a result, the stools become hard and dry and are nat- 
urally more difficult to expel. Water is as essential 
for infants and children as for adults. And when 
given freely several times daily, it is a simple means 
of helping to avoid and aiding in the relief of consti- 
pation. 

To establish the habit of regularity in bowel move- 
ment is of great importance. As early as the fourth 
month it is possible to begin to train the child to have 
stools at regular intervals. At stated periods each day, 



CONSTIPATION OF CHILDREN 95 

he should be placed upon a small bowl or infant's 
chamber. This should be small enough to comfort- 
ably fit the buttocks and in order that the baby's back 
may be supported should rest on the lap. Once or 
twice a day he should be placed on this vessel. The 
best time to select for the first effort is shortly after 
the first feeding. This is true, not only because, when 
taking food into the stomach a worm-like motion is 
started along the intestinal tract, tending to move for- 
ward its contents, but it is well to establish the habit 
of moving the bowels the first thing every morning. 
If not convenient to do this after the first feeding, it 
may be left until the second. While the effort may 
not in the beginning be successful, if persisted in the 
child will be sure to respond to the regularity and thus 
the habit of moving the bowels at a certain time each 
day will become established. The important point to 
remember is that the effort must be made at the same 
time each day. 

When old enough to sit up unsupported, the child 
should be put to stool on a comfortable chair, low 
enough to allow the feet to rest on the floor. The 
adult chamber, since it tends to allow displacement of 
the organs, not permitting the child to strain to any 
purpose, should not be used for children. 

It is hardly possible to begin too early to educate 
the intestine into the regular unaided performance of 
its natural function. A habit early established and 
later understood by the child will not be easily broken. 



96 THE CARE OF CHILDREN 

In fact, it is likely to be carried through life. On the 
other hand, if the habit has not been formed and the 
child is left to make known his wants, it is easy to see 
how he may become constipated. The child prefers 
to play rather than spend the time attending to his 
toilet obligations. And even if he has felt the inclina- 
tion, this may be repressed. A regular performance 
of this function must not only be early established, 
but the child must be taught to go to stool at the same 
time each day and remain until his bowels move. 

Sometimes there is about the rectum some abnor- 
mality, such as cracks or slight tears in the mucous 
membrane just inside the anal opening, or a relaxed 
condition of the rectum, called prolapse. While both 
these conditions may have, in the first instance, been 
caused by constipation (diarrhoea may also cause fis- 
sures) their continuance may be a cause for constipa- 
tion. The first condition, because of the pain pro- 
duced by the passage, causes the child (particularly 
the older children) to put off the ordeal as long as 
possible. The second condition results in more or 
less inability to expel the movements. Abnormalities 
such as these always require the care of a physician. 

And now just what is constipation? Is it merely 
inability to have a daily stool without artificial assist- 
ance? 

No. In the healthy child there must be not only 
a daily evacuation but this must be normal. Even 
though there may be a daily movement and possibly 



CONSTIPATION OF CHILDREN 97 

more, if this is dry and comes away in hard pieces, the 
child is still constipated. 

During the first six: months, infants usually have 
two stools daily. Many may, however, have only one 
and if this is normal in character, constipation is not 
present. The stools of the bottle-fed baby, while 
not likely to be as frequent (when feeding is properly 
carried out) as in the breast-fed, are larger and more 
bulky. 

The aim should always be to relieve constipation 
by dietetic measures and habits of regularity. If, how- 
ever, these fail, temporary relief must be obtained by 
recourse to other expedients. 

Massage of the abdomen will often aid in the relief 
of constipation. It is best given for about five min- 
utes night and morning. Let the child lie on his back 
with abdomen exposed. Then, after moistening the 
hand with warm olive oil, albolene or vaseline, gently 
massage the abdomen, using a light circular motion 
and very little pressure. Begin just above the right 
groin, proceed to the margin of the ribs, then across 
the body and down on the left side. This should 
never be done just after feeding and always, to avoid 
chilling, care should be exercised. 

If when putting the child to stool results are not 
forthcoming, the use of a soap stick or gluten sup- 
pository may be all that is necessary to bring on an 
action. In an effort to establish the habit of moving 
the bowels at a certain hour, the gluten suppository 



98 THE CARE OF CHILDREN 

may be used for several successive days, but should be 
employed only as a temporary measure. 

When the child is badly constipated and needs im- 
mediate relief, it may be necessary to give an enema 
of plain warm water (95 degrees), or, in especially 
severe cases, of warm olive oil, one or two tablespoon- 
fuls. In older children when the constipation is es- 
pecially obstinate, an enema of two or three ounces 
of warm olive oil is often given at bedtime for sev- 
eral successive nights. This is given through a very 
small rubber tube attached to a bulb syringe. The 
oil is intended to be retained until morning when after 
breakfast the child is placed at stool. 

Enemas should not be commonly employed. When 
used promiscuously they may for two reasons result 
in more stubborn constipation. 

First, their indiscriminate use tends to cause the 
bowel to lose its tone and to soften and dilate the 
bowel wall. 

Second, the child soon learns to wait for this stim- 
ulation and does not have a stool without it. For these 
reasons their use should be supervised by a physician 
in order that the character and frequency of the enema 
may in each case be adjusted to the needs of the in- 
dividual child. 

Drugs should never be used unless ordered by a 
physician. The use of castor oil for chronic con- 
stipation is to be avoided, since its after effects are 
constipating. 



CONSTIPATION OF CHILDREN 99 

By means of dietetic measures, persistence, regular- 
ity, and massage, constipation in infants and children 
may be overcome. Of these expedients not the least 
is regularity, since children are made up of habits, 
good habits or bad habits. 



CHAPTER XIII 

INFECTIOUS DISEASES 

The old idea still persists, unfortunately, in many 
instances, that it is wise to expose children to the com- 
mon contagious diseases, in order that they may have 
these so called "Children's Diseases" and be through 
with them. This belief is entirely erroneous. For 
contagious disease, even in mild form, holds possi- 
bilities of more serious consequences. That is, the 
greatest danger in most instances does not come dur- 
ing the ordinary course of the illness but rather as a 
result of complications. This being true, all children 
and particularly young children, should be zealously 
guarded against exposure. 

Contagious diseases are carried generally by means 
of bodily secretions of those who are ill. For this 
reason, it is imperative that young children showing 
symptoms of disease, should be isolated from other 
children until it has been determined whether or not 
contagious disease is present. It is usually possible to 
determine this after twenty-four hours or at the most 
forty-eight hours. 

Some diseases, such as diphtheria and meningitis, it 

is believed, may be borne also by means of carriers. 

ioo 



INFECTIOUS DISEASES 101 

Carriers are people who, while not ill themselves, har- 
bor the germs of disease and disseminate them from 
one to another. It is doubtful, however, if such carriers 
are dangerous to those who are healthy, unless coming 
into intimate personal contact with them. 

The different contagious diseases are characterized 
by certain distinctive features and symptoms. If 
these are known to the mother, she may save herself 
much needless anxety. 

Measles is probably the most common of all the 
contagious diseases. The first symptoms are those of 
a cold in the head. There is sneezing and coughing 
with much watery secretion. The eyes are inflamed 
and in most instances the child complains of the light. 
With the onset, there is also slight fever. The rash 
which consists of small irregular groups of dull red 
slightly raised spots, (which increase in size and finally 
run together) does not make its appearance usually 
until the morning of the fourth day. This is generally 
first seen upon the forehead, then upon the neck and 
chest, until finally it covers the entire body. The 
eruption, after the second day, begins to fade. While 
measles should never be regarded as of slight conse- 
quence, it is particularly dangerous for children 
under one year of age. The chief danger lies with 
the complications which may accompany or follow the 
disease. Some of these are: — 

Bronchitis, pneumonia, tuberculosis, or trouble with 
the kidneys, eyes or ears. 



102 THE CARE OF CHILDREN 

The child should be kept in bed in a cool comfort- 
able room and the eyes should be protected from light. 
As a generous supply of fresh air is essential and 
since darkening the windows, to a certain extent cuts 
off ventilation, the eyes should be protected by turn- 
ing the bed away from the light and placing about it 
a screen. 

A child sick with measles should always be under 
the care of a physician. For it is this supervision with 
good nursing which prevents complications. Isola- 
tion is generally kept up for a week after peeling 
ceases. Children who have been exposed to measles 
should be kept from other children for a period of ten 
to fourteen days. This covers what is called the in- 
cubation period. That is the time which may elapse 
between exposure and onset of the first symptoms, if 
the child has taken the disease. 

Rubella (German Measles) resembles measles, but 
is of a very much lighter form. With this the child 
may not complain at all of feeling sick. A light rash 
appears first on the face and chest, rapidly spreading 
over the body, and within two or three days fading 
away. The eyes become slightly reddened and there 
may be a little temperature. One of the most character- 
istic symptoms to be noticed is an enlargement of the 
glands back of the ears. These appear as rounded, 
irregular prominences and are generally tender upon 
pressure. German measles is very infectious. While 
it needs little other than good nursing care, isolation 



INFECTIOUS DISEASES 103 

for about a week should be enforced. The time 
within which the disease may develop after exposure 
(the incubation period) is about ten days. 

Scarlet fever, while not so infectious as measles, 
is much more serious. This disease generally mani- 
fests itself very suddenly. The first symptoms noted 
may be a sore throat, severe headache with high fever, 
or the child may vomit and become ill. The rash 
which consists of very fine spots so close as to make 
the entire skin appear bright red, appears generally 
within twenty-four hours after the onset of illness. 
This is seen first on the neck and upper part of the 
chest, later spreading to other parts of the body. The 
duration of the rash is variable. This depends upon 
the intensity of the attack. It may last anywhere from 
three to ten days. Within a period varying from a 
week to ten days, the skin of the body begins to peel 
off. This may be completed about the twelfth day or 
it may be in process three weeks or more. Scarlet 
fever, no matter how mild it may seem, should never 
be viewed lightly, for always there is danger of seri- 
ous complications accompanying or following this dis- 
ease. Some of the most serious of these are: — 

Nephritis (inflammation of the kidney), inflamma- 
tion of the middle ear, arthritis (inflammation of the 
joints) and heart affections. 

A child who has been exposed to scarlet fever should 
be kept from other children for a period of a week. 
This covers what is called the incubation period, 



104 THE CARE. OF CHILD.REN 

(time between date of exposure and date of onset) 
if the child has taken the disease. 

Chicken-pox is another contagious disease produc- 
ing a rash. With this quite frequently there are no 
early symptoms, the appearance of the rash being the 
first indication. The eruption consists of small raised 
pimples which later become filled with fluid. Then 
within a few days over the tops of these raised spots, 
scabs form. This rash, different growths of which 
may appear, is rarely in evidence longer than ten days. 
Chicken-pox is not dangerous and needs no unusual 
care. The child should be isolated but may be allowed 
to play around in a warm, well-ventilated room. As 
this disease is diffused through the secretion contained 
in the eruption, isolation should be enforced until all 
the scabs have fallen and the spots entirely healed. 
The incubation period (time within which, after ex- 
posure, the disease develops) for chicken-pox is about 
two weeks. So children who have been exposed 
should be kept from school whether or not they have 
developed the disease. 

Mumps is a common infectious and contagious dis- 
ease, the characteristic symptoms of which are so dis- 
tinctive, it is seldom mistaken for any other. The on- 
set is generally marked with a chill, headache and some 
rise in temperature. There is pain and swelling in 
front of the ear (at the angle of the jaw) and the 
mouth is usually dry with scant, sticky saliva. Some- 



INFECTIOUS DISEASES 105 

times there is stiffness of the jaws, making it difficult 
to open the mouth. After four or five days the dis- 
ease reaches its height and the pain and swelling grad- 
ually subside. A child ill with mumps should be 
under the supervision of a physician. The usual nurs- 
ing care is required. Isolation should be in effect as 
long as there is any swelling. The period that may 
elapse between the time of exposure and the appear- 
ance of the disease varies from eight days to two 
weeks. 

There are few illnessess more exhausting than 
whooping-cough. It is particularly dangerous for in- 
fants and young children and every effort should be 
made to protect them from this infection. The dis- 
ease is most prevalent in spring and summer and 
reaches its highest point in August. The first symp- 
toms are those of a cold in the head accompanied by 
a sharp nervous cough. The cough gradually in- 
creases until finally there is a succession of violent 
coughing attacks accompanied by a feeling of suffo- 
cation and flushing of the face. It is supposed to be 
most infectious during the initial stages. An attack 
of whooping-cough may last anywhere from three to 
eight weeks. Many mothers consider whooping- 
cough so simple they do not think it necessary to place 
the child under a physician's care. This is very unfair 
to the child. Medical advice should always be secured. 
Under the best treatment the disease may not only be 



io6 THE CARE OF CHILDREN 

shortened but the danger of such complications as 
bronchitis, bronchial pneumonia, tuberculosis and 
anaemia, greatly lessened. 

Children with whooping-cough should be kept in 
the open air practically all the time. Unless there are 
complications it may not always be necessary to put 
them to bed, but the paroxysms are generally dimin- 
ished if kept in bed for a time or at least kept quiet. 
If the child is weak or has fever he should be kept in 
bed but the bed should be somewhere in the open air. 
For fresh air and sunshine (without exposure) is ex- 
tremely necessary throughout the disease. Nutrition 
is an important factor. It must be kept up at any cost. 
If a child vomits a meal as soon as he has eaten it 
during a paroxysm, he should be given another with 
the probability that he will retain it long enough to be 
digested. The character of the food should depend 
upon his condition but should be that which is quickly 
and easily digested. Vomiting may be prevented by 
quiet or if the child will rest for awhile after eating. 
It is important that plenty of water be given, since 
there will be less irritation and consequently paroxysms 
less frequent, if the mucous membranes are kept moist. 
The treatment of whooping-cough is individual and 
should always be left to the discretion of a physician. 

The period that may elapse between the time of ex- 
posure to whooping-cough and the appearance of the 
disease is not definitely known, it may vary from two 
to ten days. A child who has been exposed should 



INFECTIOUS DISEASES 107 

not return to school for at least ten days and a safer 
rule is two weeks. 

The mother should always remember that if her 
child has been exposed to any of the contagious dis- 
eases, he may be a menace to other children. She 
should always feel morally bound to recognize this, do- 
ing everything possible to maintain such quarantine 
measures as will protect other children. 



CHAPTER XIV 

HOW TO CARE FOR INFECTIOUS DISEASES 
IN THE HOME 

"It is all right, she is well enough to go to school. 
In fact she is not sick at all." This was the unanimous 
verdict of the family. The subject of the conversa- 
tion was a young and robust school girl, who during 
the week-end had a very, very slight attack of Rubella 
(German measles), so light in fact she felt indisposed 
for only a day and no one outside the family knew she 
had had the initial symptoms. 

The family conclusion was correct so far as saying : 
"She is not sick at all/' That she might give this dis- 
ease to others less strong than herself seems not to 
have entered their minds. But this was grossly un- 
fair. For it was only a week hence that a message 
came from the mother of this little girl's chum asking 
her not to stop for Mary on her way to school, as she 
was quite sick with Rubella. 

Nowhere is it more applicable than in connection 
with communicable diseases to paraphrase the golden 
rule : "Do yourself what you would desire of another 
whose child might be a source of danger to your own 
family." For if no one passed them on to any one 
else, communicable diseases would come to a standstill. 

108 



CARE FOR INFECTIOUS DISEASES 109 

The spreading of most diseases is due to carelessness. 
As it is often impossible, in the beginning, to distin- 
guish between the infectious and non-infectious, it is 
wise to separate children until the true nature of the 
disease is known. If found to be infectious or con- 
tagious, the separation must be kept up until there is no 
danger of giving it to others. Now, how can isola- 
tion be carried out in the home ? 

First, select a bright sunny room at the top of the 
house, removing all unnecessary articles, such as up- 
holstered furniture, draperies or rugs. It is very de- 
sirable that the floor be bare in order that it may be 
mopped every second or third day with carbolic solu- 
tion 1-40. The dusting should also be done with a 
cloth dampened with this solution. If the disease is 
highly contagious, further precautions may be taken 
by hanging up a sheet dampened in 1-20 carbolic, in 
the line of air currents. It will be necessary to pro- 
vide : — 

One large foot tub for use in disinfecting the bed 
clothing 

One medium-sized covered pail in which the water 
used in bathing the child and other secretions may 
be disinfected before being carried to the toilet 

Two wash basins, one to be used when bathing the 
child, the other for cleansing the hands after car- 
ing for the child 

One hand brush for use in cleansing the hands, after 
contact with the child or any of the secretions 

Several large paper bags in which may be placed 
gauze or cotton swabs for burning 



no THE CARE OF CHILDREN 

One round basin for use in washing dishes 
One mop and a small dusting basin 

In addition there should be a large glass bottle or 
some container for carbolic solution and if possible 
some way of providing hot water without the necessity 
of going to the kitchen. If a room can be had adjoin- 
ing a bath-room isolation can be made much simpler. 
It will, of course, solve the necessity of bringing 
water from any other part of the house. The bed 
linen can then be disinfected in the bath tub and of 
course the stationary wash basin may be used for 
cleansing the hands. Anything that is taken into the 
sick-room should be left there. Only one person should 
care for one in isolation and no other member of the 
family should be allowed in contact. When entering the 
room and before approaching the bed the hair should 
be covered with a cap or large handkerchief and the 
clothing should be protected by means of a long gown. 
These should hang just inside the sick-room, easily 
accessible upon entering. They should not be worn 
outside the room. 

All the discharges should be disposed of carefully. 
Those from the mouth and nose should be received in 
gauze or cotton, deposited in a paper bag and burned 
at least once a day. Those from the bowels and bladder 
should be received in a china vessel, disinfected with 
chloride of lime and allowed to stand for an hour. 
If chloride of lime cannot be obtained milk of lime 



CARE FOR INFECTIOUS DISEASES in 

may be used. This may be made by adding one part 
of slacked lime to four parts of water. 

After handling the child or any of the secretions, 
the hands should be scrubbed with warm water and 
soap (running water preferably) then soaked for a 
few minutes in bichloride solution i-iooo. Special 
care should be used in washing the hands before going 
to meals. 

All linen used for the sick child or on the bed should 
not be taken from the room until it has been soaked 
for twelve hours in a 1-40 solution of carbolic acid. 
After this it should be wrung from the solution, trans- 
ferred to a covered pail and boiled separately from the 
clothes of the other members of the family. 

The dishes used in the sick-room should be left 
there. The refuse should be scraped into a paper bag 
and burned. If too many dishes accumulate, they 
may after a thorough washing in hot water, be trans- 
ferred to a pan which has been left at the door, taken 
to the kitchen, covered with cold water and boiled. 
After dishes have boiled for five minutes, it is perfectly 
safe to use them. 

In caring for cases of high fever it is important that 
everything possible be done to prevent the child from 
exerting himself. Exertion will not only cause an eleva- 
tion of temperature but also an acceleration of the 
pulse rate. This adds to the tissue waste and in- 
creases the strain upon the heart. 



H2 THE CARE OF CHILDREN 

There should be a constant supply of fresh air with- 
out exposure to drafts. The bed should be carefully 
looked after and kept fresh. 

That the mouth be cleansed frequently is most 
important. Not only is this essential for the comfort 
of the sick one, but also to check bacterial growth 
and reduce the chances of complicating inflamma- 
tions. 

The period of quarantine or isolation for the con- 
tagious or infectious diseases is varying in length. 
This should be decided by the physician. 

After recovering there should be a general bath of 
hot water and soap. This should include a thorough 
washing of the hair, a close cutting of the nails (fin- 
gers and toes) and cleansing under the nails. The 
child should then be wrapped in a clean sheet and taken 
to another room. 

The room which has been vacated should be thor- 
oughly cleaned and aired. The floors and woodwork 
should be washed with hot water and soap and then 
gone over with a soft cloth wrung from 1-40 solu- 
tion of carbolic. The mattress and pillows should 
be brushed with a whisk broom which has been lightly 
dipped into carbolic solution. The blankets should be 
sunned and aired for several days. 

For most infectious diseases fumigation is now con- 
sidered unnecessary if the room is subjected to a 
thorough cleaning and airing. 

To make a 1-40 solution, one calculates the amount 



CARE FOR INFECTIOUS DISEASES 113 

equal to %o of the whole solution. Thus to make 
a quart of 1-40 carbolic solution: — 

A quart being equal to thirty-two ounces, the 
amount of pure carbolic required would be %o of 
thirty-two ounces — 3 %o or % of an ounce, and as 
there are eight drachms in an ounce, the amount re- 
quired would be a little less than 6^ drachms (tea- 
spoonfuls). It is better to make a more concentrated 
solution (1-20) or 5%, which would require twice as 
much acid. From this as a stock the weaker solution 
of 2%% or (1-40) may be made by diluting one half. 

When making up a solution of carbolic be sure to 
use very hot water, otherwise globules of the acid may 
remain undissolved and any one of these will burn 
living tissue. In case of a burn apply alcohol. Pure 
carbolic will frequently return to the crystal state. 
When this happens, place the bottle in a deep vessel in 
warm water, standing it on a saucer or some absorb- 
ent cotton, place over the fire and before the water 
reaches the boiling point crystals will have dissolved. 
Always be sure to remove the stopper when placing 
pure carbolic over the fire, otherwise the gases being 
unable to escape may cause an explosion. 

The bichloride solution may be made by dissolving 
one tablet in a pint of warm water. This solution 
should be changed every day. 

Both carbolic and bichloride are deadly poisons and 
bottles containing these should not be placed where 
they might be mistaken for other things. 



CHAPTER XV 

THE BIRTHRIGHT OF BEAUTY 

The advantages of good looks are too obvious to 
need comment. The substructure of beauty is the 
birthright of every child. "So many objectionable- 
looking people that we see ivery day upon the strate," 
according to Mr. Dooley, "are the survivals and left- 
overs of the age of barbarism and ignorance." 

Nature is seldom so lavish of her gifts as to war- 
rant trifling with her handiwork. Ninety-five out of 
one hundred children will, if intelligently handled, 
develop a good background for beauty. And yet, in 
many children the natural inheritance is often hindered. 

How ? By lack of vigilance during infancy. Some 
things must be guarded against to insure to each child 
his birthright of beauty. 

First, we would mention the habit of sucking a rub- 
ber nipple, commonly called a "pacifier,' ' thumb suck- 
ing or finger sucking. This habit injures the health 
and also lessens the chance for beauty. 

The perfect mouth should be of medium size, the 
upper lip bow-shaped and the under nearly straight, 
while the lips should not be too thick. The child 
may have inherited in every respect a perfect mouth, 

114 



THE BIRTHRIGHT OF BEAUTY 115 

but the constant exercise to which the parts are sub- 
jected, if allowed to suck continually on anything, is 
conducive to thick lips. The protrusion of the upper. 
jaw> also, spoils the natural arch of the mouth. The 
constant sucking also contributes largely to a narrow- 
ing of the jaws (thrusting the upper jaw forward) 
and to a narrowing of the roof of the mouth. 

It spoils the natural shape of the mouth and causes 
thick lips. The jaws do not bear the proper relation 
to each other; consequently, the teeth do not meet 
correctly and have a tendency to bulge outward. 

The "pacifier" habit may be controlled in several 
ways — by using a mitten — by pinning the sleeve 
down over the offending hand for several days and 
nights, or by pinning the sleeve to the dress or bed- 
clothes. If the baby is old enough to use his hands 
for playing with toys, they should be set free from 
time to time. During this time, if the fingers are put 
into the mouth they should be at once removed and 
the child's attention diverted. At sleeping time, the 
hand should be so arranged as to prevent the baby 
getting it to his mouth, as long as the habit persists. 

Some children develop the habit of ear-pulling. 
The child pulls on either one or the other ear during 
most of its waking hours and generally when going to 
sleep. The favorite point of attack may be the lobe of 
the ear or it may be the upper portion. The result, 
however, is the same — the ears are pulled out of shape. 
This habit may be controlled by bandaging the hands, 



n6 THE CARE OF CHILDREN 

using a light piece of pasteboard as a splint to prevent 
bending the fingers, which prevents the child from 
grasping the ear. Sometimes the ears have a tendency 
to protrude even though the child may not pull upon 
them. When this is the case care should always be ex- 
ercised to see that the ear is flat when the baby is put 
down. Later, when the child becomes more active, 
if the ears appear to be too prominent, they should be 
kept back tight to the head by a skeleton bonnet made 
of tape. This should come well down over the ears 
and tie under the chin. 

Eyes are a determinant factor in appraising beauty. 
No one thing so affects one's first impression of a per- 
son, obviously attractive, as large, clear, well-opened 
eyes. And what are the defects acquired in early 
life which mar an otherwise beautiful eye? 

Barring accidents and infection, the most serious 
defect in a beautiful eye is "cross-eye." So often 
when this develops in young children, parents wait for 
the child to outgrow it. This is a great mistake. The 
child should be placed in the hands of a competent 
physician who will correct it by means of a simple 
operation. This is most important not only from the 
standpoint of beauty, but in order to preserve the 
sight in an eye that otherwise may become practically 
useless. Preventable also are eyes apparently half- 
closed, commonly called "squint-eye." Squint-eye 
is in most instances caused by far-sightedness, often 
combined with astigmatism. The squint develops 



THE BIRTHRIGHT OF BEAUTY 117 

usually between the ages of one and five. It is 
brought about in most cases through use of the eyes 
which need corrective glasses for the far-sightedness, 
making close observation difficult. Squinting may 
also be a habit. It may be caused by placing a young 
child where he may stare at a strong light. A baby 
is like a moth ; he is fascinated by strong lights. 

In answer to a question we recently put to an artist 
as to the keystone of beauty building, we received the 
answer: "Even, white teeth and a perfect mouth." 
We believe all are agreed that no one feature so de- 
tracts from personal beauty, as misshapen, crooked or 
protruding teeth set into a malformed mouth. The 
foundation for a strong, beautiful set of teeth is laid 
in infancy. The food the baby receives during the 
first nine months of life is a great factor in the child's 
dental development. If the diet is poorly balanced, if 
the sugar and starch content is too high, and the fat, 
tissue-building and mineral substances too low, it has 
a pernicious effect upon the teeth in later life. The 
"pacifier" habit, thumb and finger sucking are also 
detrimental to the development of even, properly 
placed teeth. 

The care of the first teeth is extremely important. 
Until the end of the second year, the baby's teeth are 
best cleansed by wrapping a clean index finger with ab- 
sorbent cotton and dipping this into a solution of 
boracic acid, applying it with gentle friction to the 
teeth and gums. After the second year the teeth 



n8 THE CARE OF CHILDREN 

should not be lost or extracted prematurely, since in 
addition to other things, this permits shrinking and 
warping, leaving insufficient room for the new and 
larger teeth. The decay of the teeth is most rapid 
between the ages of six and fifteen, perhaps due to the 
fact that this is the period of most rapid body growth. 
In addition to the most painstaking care from the 
standpoint of cleanliness, teach the child to finish his 
meals with some slightly acid fruit, rather than sweets, 
since acid fruits stimulate the secretion of slightly 
alkaline saliva. And how does this alkaline saliva 
protect the teeth? 

It is the acids in the mouth, formed as a result of 
certain bacteria always present in the mouth, feeding 
on the decomposing products of certain kinds of food, 
principally sweets and starchy foods, which attack the 
teeth. When the last article of food is such as to 
cause an alkaline flow of saliva, it acts as a protection 
to the teeth. This saliva is not only Nature's anti-acid 
mouth wash, but it coats the teeth and prevents them 
from being etched by the decomposing food products 
which would otherwise remain. 

Girls are dependent upon the beauty of their hair 
for a large measure of their attractiveness. If there 
is an abundance of natural oil, one shampoo a week 
is sufficient, while if it appears to be dry and brittle, 
once in two weeks will suffice. The essential thing 
is cleanliness. 

During early childhood, short hair not only pre- 



THE BIRTHRIGHT OF BEAUTY 119 

vents excessive perspiration about the neck and head, 
which might be a cause for taking cold, but it enables 
one to keep the scalp in a more healthful, active con- 
dition. 

What is more lovely than the clear, velvety skin of 
the young? This should be carefully guarded; espe- 
cially is this true of girls. If cold winds make chap- 
ping a frequent occurrence, leaving a rough skin, 
it should be overcome by applications of cold-cream, 
which will insure a better complexion as they grow 
older. Use a dry cream and rub in thoroughly. 

A well-shaped hand has always been the delight of 
artists. A habit most disfiguring to the fingers is 
nail-biting. Children who acquire this habit are gen- 
erally very nervous or their general health is below 
par. Every means should be used to break up the 
habit and to build up their general health. 

When building for beauty the lower extremities 
should not be overlooked. So many children are 
allowed to grow up with "bow-legs," which are partic- 
ularly disfiguring all through life. The chief cause 
for bow-legs is thought to be some nutritional dis- 
turbance in early life which prevents proper harden- 
ing of the bones. "Bow-legs" may also be caused by 
allowing children to walk too early, especially heavy 
children. During the early years, while the bones 
are still pliable, "bow-legs" are easily corrected by the 
wearing of braces especially constructed under the 
direction of an orthepedic surgeon. In mature child- 



120 THE CARE OF CHILDREN 

hood, the correction of "bow-legs" may necessitate 
an operation. 

Train the child to place the feet properly. The 
feet should be parallel in standing and walking, toes 
pointing straight forward. This is not only the most 
healthful attitude, since it allows the weight of the 
body to be evenly distributed, but it is also the most 
graceful foot position. 

If children are fortunate enough to receive early 
attention and care, they will grow up with a back- 
ground which, when colored with health, will make 
charming human pictures. 



CHAPTER XVI 

IS MY BABY ALL RIGHT? 

With an inexperienced mother, not knowing 
whether or not her baby is thriving, it often happens 
either that she becomes unduly alarmed at small mat- 
ters, or fails to appreciate the serious nature of cer- 
tain abnormal conditions. 

In the growth and development of children, there 
are certain characteristics common to them all and of 
these every mother should have an intelligent under- 
standing. 

The average baby at birth weighs about seven 
pounds. During the first few days or the first few 
weeks of life, there is some loss in weight, varying 
from a few ounces to even a pound. Within four to 
ten days the baby should have returned to its birth 
weight and from this time on there should be a steady 
increase. The most rapid gain in weight is from 
the first to the third month, while the slowest gain 
is usually from the sixth to the ninth. Generally, 
at the end of six months, a baby will have doubled 
its birth weight and at the end of a year trebled it. 
Bottle-fed babies do not, as a rule, gain as rapidly at 
first as do breast-fed babies, but if properly fed the 
gain during the later months is about the same. 

121 



122 THE CARE OF CHILDREN 

While there should be a constant growth in stature, 
this is not as regular or as important as the question 
of weight. Usually, at the end of a year, the average 
child has grown about nine inches in height. About 
five inches of this stature is generally gained during 
the first six months and four inches during the last 
six months. During the second year, the average gain 
in height is about three and five-tenths inches. And 
from this time until the eleventh year there should be 
a gain of from two to three inches a year. 

All new born babies have at the top of the head, a 
soft spot. This is an inch and sometimes an inch and 
a half in diameter. It is called the anterior fontanelle. 
When the child is about fourteen months old, this 
should begin to close and by the twentieth month or 
the end of the second year, should be entirely covered 
over with bone. If at the end of the second year, 
this soft spot is still present, a physician should be con- 
sulted. For it means always that the child is not de- 
veloping properly. 

There is also at birth, usually, a soft spot at the 
back of the head. This is called the posterior fonta- 
nelle. Generally this spot is covered over with bony 
tissue at about the sixth week. 

Some babies during the early weeks of life appear 
to be cross-eyed. This condition, unless it persists 
after the third or fourth month, need cause no con- 
cern. If, however, after this period, the cross-eye still 
continues, it should be called to the attention of the 



IS MY BABY ALL RIGHT? 123 

physician. The eyes coordinate at about the third 
month. And beginning with the fifth or sixth months 
objects are recognized. 

While an infant is deaf for the first twenty-four 
hours after birth, the sense of hearing is acute as early 
as the fifth or seventh day. A baby usually begins to 
recognize familiar voices from the third to the sixth 
month. 

At average times various evidences of intelligence 
appear and all mothers should know when these may 
be expected. For if too long delayed it may mean 
that something is wrong. 

During the fourth month the baby learns to hold 
its head unsupported. Anywhere from the third to 
the fifth month he begins to laugh aloud; between the 
fifth and seventh month, he will reach for toys and 
hold them in his hands. A baby is usually able to sit 
erect without support and hold the spine upright at 
seven or eight months of age. 

Creeping begins sometimes as early as the sixth 
month. The first attempts at bearing the weight on 
the feet are generally between the ninth and tenth 
month and usually a baby can with assistance stand at 
about the eleventh or twelfth month. Babies should 
not be urged to stand alone too soon. In fact, most 
children, especially those who are heavy, need moderate 
restraint rather than encouragement in their efforts at 
standing and walking. For it should be remembered 
that not only are the bones of a young child pliable, 



124 THE CARE OF CHILDREN 

but the muscles and ligaments are at first lacking in 
strength. And while this strength is gained by use, 
such use should come about very gradually. Attempts 
at standing and walking too early may cause a curving 
of the bones, otherwise known as bow-legs. The 
eleventh or twelfth month is early enough to begin 
standing a baby alone. A child is generally able to 
walk along about the fifteenth or sixteenth month. 

Usually, at one year of age, a few words can be 
spoken and by the end of the second year, a child is 
generally able to make sentences of two or three 
words. Girls usually talk earlier than boys. While 
the time of speech development varies greatly, if de- 
layed after two years, the child should be placed under 
the care of a physician. 

Some young children have protruding abdomens. 
As a rule this need cause no concern, but if the child 
cries when lifted and otherwise shows signs of ten- 
derness about the bones, some disturbance of nutrition 
may be suspected, and a physician should be consulted. 

The teeth appear in groups. There are five of these 
groups and between their appearances various inter- 
vals elapse. The incisors (central teeth) are usually 
the first to appear. Generally, between the sixth and 
ninth month, they begin to cut through the gums. 
After the first teeth appear, there is usually a pause of 
from five to eight weeks before the next group begin 
to cut through. After the second group, there may be 
a pause of from one to three months before the appear- 



IS MY BABY ALL RIGHT? 125 

ance of the third group. Thus, by the time a baby is 
one year old, there may be six teeth. After the third 
group of teeth there may be a lapse of two or three 
months, before the first molars (the fourth group) 
appear. The fifth and last group, the second molars, 
come through anywhere from the twenty- fourth to the 
thirtieth month. 

There are twenty of the milk teeth, ten in each jaw. 
The order of their appearance is generally : — 



First incisors (central teeth) 


lower jaw 


6th to 9th month 


it « 


upper jaw 


8th to 12th 


it 


Second " 


lower " 


12th " 15th 


tt 


tt tt 


upper " 


8th " 12th 


tt 


The canine or "stomach" 


lower " 


18th " 24th 


tt 


« « « eye „ 


upper " 


18th " 24th 


tt 


First molars 


lower " 


1 2th " 15th 


tt 


<i « 


upper " 


15th 


tt 


Second molars 


lower " 


24th " 30th 


it 


« « 


upper " 


24th " 30th 


ft 



If in cutting the teeth the average is not followed, it 
need cause no concern, since there may be consider- 
able variation not only as to time, but in order of ap- 
pearance. If, however, by the end of the first year, 
no teeth have come through, a physician should be 
consulted. While dentition may be considerably de- 
layed in normal cases, it frequently means that due to 
improper feeding, the child is not developing properly. 
The first set of teeth, known as the "milk" teeth, are, 
beginning about the sixth year, replaced with the per- 
manent or second teeth. 

And what do we mean by a normal baby? 

We mean that it is not necessary for a child to do 



126 THE CARE OF CHILDREN 

everything on schedule time, since children differ in 
the rapidity of their development. We mean that the 
normal baby not only gradually develops in body and 
mind, but has a look of health and well-being. 



CHAPTER XVII 

SUDDEN EMERGENCIES OF BABYHOOD 

Since a physician is not always within reach, every 
mother should be prepared for at least the common 
emergencies. The first consideration looking toward 
this is the equipment of the nursery medicine cabinet. 
This should contain only simple medicines and appli- 
ances, never anything the use of which is not thor- 
oughly understood. 

The equipment outlined below is applicable to the 
nursery cabinet : — 

Material and Appliance. 

Absorbent cotton 
Package of sterile gauze 
Hot water bag 
Medicine dropper 
Medicine glass 
Soft rubber ear syringe 
Fountain syringe 
Small basin (kidney shaped) 
Clinical thermometer 
Package of wooden tongue depressors 
Bandages, two inch and four inch 
One roll of adhesive plaster one inch wide 
One pair small dressing forceps 
One pair scissors 
Two bent glass drinking tubes 

127 



128 THE CARE OF CHILDREN 

Ointments, Crystals and Powders 

Vaseline 

Zinc Oxide (salve and powder) 

Cold cream 

Talcum powder 

Soda Bicarbonate 

Boracic acid 

Powdered mustard 

Internal Medicines i 
Castor oil 
Petrolatum 
Milk of magnesia 
Syrup of Ipecac 
Sweet Spirits of Nitre 
Soda-Mint Tablets 
Sweet oil 
Lime water 

External Usei 

Tincture of Iodine 
Alcohol, ninety-five per cent. 
Witch Hazel ' 

And now let us consider some of the sudden emer- 
gencies with which a mother may be confronted. 

Convulsions: A convulsion may come on suddenly 
or gradually and one predisposes to another. While 
the vast majority are due to indigestion and constipa- 
tion, some of the diseases of children are ushered in 
with convulsions. With the first appearance of a con- 
vulsion, a physician should be summoned. While 
awiaiting his arrival, place the child at once in a 
warm mustard bath (temperature one hundred to one 



EMERGENCIES OF BABYHOOD 129 

hundred and five degrees F.). To a small foot-tub 
three quarters full of water use two teaspoon fuls of 
mustard or four teaspoonfuls to five gallons. Before 
adding the mustard to the water tie it into gauze or 
make into a paste. If a bath thermometer is not at 
hand, test the temperature of the water with the elbow. 
The baby's head, to which cold compresses should be 
applied, should be kept raised. That is, it should rest 
in the hollow of the left arm, while with the right 
hand the body should be rubbed vigorously. The baby 
should be kept in the bath only about five minutes 
(never longer than ten minutes) then without drying 
wrapped in blankets. In the meantime, if the physi- 
cian has not arrived, give a soap-suds enema (made 
from castile soap) using one pint of water in the bag 
of a fountain syringe. As soon as the child can swal- 
low, he should be given two teaspoonfuls of castor oil. 
For the next twenty- four hours great care should be 
exercised in feeding. For a bottle-fed baby, only 
barley water should be given and for an older child, 
broths should take the place of milk, no solid food 
being given. A child who has had a convulsion 
should be carefully guarded against excitement for 
the next few days. 

Croup: The onset of croup is very sudden. The 
child goes to bed apparently well, awakening within a 
few hours in great distress with labored breathing and 
a hoarse cough. Children with enlarged tonsils and 
adenoids, it is believed, are more subject to it than 



130 THE CARE OF CHILDREN 

others. Whenever a baby has an attack, the doctor 
should be summoned, since in addition to other things, 
it is imperative that one make sure the child is not 
suffering from laryngeal diphtheria, called membra- 
nous croup. In the meantime, the child may be given 
a teaspoonful of syrup of ipecac, which if vomiting 
has not occurred, may be repeated in fifteen minutes. 
A hot moist atmosphere is of much service in causing 
the paroxysm to relax. This may be brought about 
by the use of a croup kettle — a kettle with a long 
spout enabling the steam to be carried where needed. 
If this is not at hand, a steaming tea kettle, kept boil- 
ing by means of an alcohol lamp or gas stove, may be 
used. The inhalation is always more effective if the 
child is confined under a tent. Such a tent may be 
rigged up by covering the bed with a sheet or a large 
umbrella, allowing the spout of the kettle to rest 
under it. Great care must of course be exercised not 
to burn the child or set fire to the bed. A mild attack 
of croup will often yield to the application of cold 
moist cloths about the throat. For this, fold a soft 
cloth into four or five thicknesses, place in cold water 
(60 degrees F.) and after wringing it dry, place about 
the throat from ear to ear. This should be covered 
with a piece of oiled silk and held in place by means of 
a handkerchief or small towel. The compress should 
be renewed every fifteen or twenty minutes. When 
the attack has subsided, remove all damp clothing and 



EMERGENCIES OF BABYHOOD 131 

gradually cool the room while keeping the child warmly 
covered. 

Earaches: Infants and young children are very sus- 
ceptible to earache, particularly during winter. It 
may accompany or follow a cold or such diseases 
as diphtheria, measles, whooping-cough or pneumonia. 
With very young babies sometimes the only indication 
of trouble is sharp crying with high fever and restless- 
ness. Older children usually put the hand to the 
affected ear or toss the head from side to side. The 
best way to relieve earache is by a hot irrigation of 
boric acid, temperature no degrees F. (see Chapter 
XXII). Such simple measures as a few drops of 
warmed sweet oil dropped into the ear or the application 
of a hot water bag or salt bag (warmed in oven) when 
applied to the affected side will often give relief. Be- 
fore dropping warmed sweet oil into the ear, the mother 
should always first test it in her own ear, to be sure it 
is not too hot. Persistent earache always demands 
the attention of a physician. 

Foreign Bodies Swallowed: It is seldom that foreign 
bodies swallowed cause harm. The important thing 
to remember is that a cathartic should not be given. 
In case of an older child give bread, potato or any 
coarse food, while a child as old as six months may 
have oatmeal or cornmeal mush. These are given in 
the hope that they may form a mass around the object 
(thus preventing injury) while it is carried forward 



i 3 2 THE CARE OF CHILDREN 

through the stomach and intestines. If the foreign 
body is not found in the stool, the child should be 
taken to a physician for x-ray examination. 

If an object lodges in the throat, hold the child up- 
side down while an assistant slaps him on the back. 
If not coughed up and the breathing is still difficult, 
it may possibly be dislodged by forcing the index 
finger far back into the throat. 

Foreign Bodies in the Ear or Nose: A foreign 
body in the ear should be removed only by a physician, 
since efforts in this direction by an untrained person 
may serve only to push it in further, making final re- 
moval more difficult. 

A foreign body in the nose may often be forced 
outward by placing one finger against the unobstructed 
nostril, while the child blows his nose. If this does 
not remove the object, leave it, without "poking at 
it" until the arrival of a physician. 

Foreign Body in the Eye: The upper lid is the 
usual location of a foreign body. Often its removal 
can be accomplished by such a simple process as: 
Grasping the upper lashes with the thumb and index 
finger, pulling the lid away from the eye and well 
down over the lower lid before letting go the grasp. 
By this method the lower lashes sometimes sweep 
away the offending particle. If, however, this does 
not remove it, then the upper lid should be everted. 
To do this: Grasp the eye lashes of the upper lid 



EMERGENCIES OF BABYHOOD 133 

firmly between the tips of thumb and forefinger, then, 
while the eyes look downward, turn the lid over a 
small lead pencil or pen holder, gently wiping away 
the object, if it can be seen, with the pointed fold of a 
clean handkerchief or a small swab made of a little 
absorbent cotton wrapped around the end of a tooth 
pick or the stem of a match. It is better to moisten 
the point of handkerchief or swab with sterile water 
or a solution of boric acid before using. Never use 
saliva, as the eye is easily infected. Do not attempt 
to wipe a particle from the eye with the ball of the 
finger. There is danger of scratching the cornea with 
the finger nail. 

Nosebleed: Nosebleeds, if continually occurring, 
generally mean an ulceration in the nose. This should 
receive special treatment. At the time of the nose- 
bleed keep the child in an upright position, making 
pressure with the thumb and forefinger just below 
the bridge of the nose. A small piece of ice may be 
wrapped in a towel and held on the affected side, after 
releasing pressure. Do not allow the child to blow 
the nose as long as there is any danger of renewed 
bleeding. 

Hiccough: In infants this may be caused by some 
form of stomach irritation, such as, swallowing air 
while taking food or taking too much food, thus over- 
filling the stomach. It may also be induced by sudden 
exposure to cold. Relief may be brought about by 



134 THE CARE OF CHILDREN 

a drink of water, gentle massage of the abdomen or 
sometimes merely by placing the baby face down- 
ward across the lap. 

Wounds: When the skin has been broken, next in 
importance to controlling the hemorrhage (if any) is 
the prevention of infection. Do not handle the wound. 
After washing the hands thoroughly, twist a piece of 
absorbent cotton around a tooth pick and with this 
apply iodine around the edges on all sides to a depth of 
about one inch away from the wound. Remember that 
the iodine must always be diluted. Iodine that has 
stood becomes very strong and if used without being 
diluted may cause a bad burn. The safe way to use 
iodine is to pour off a small amount in a medicine glass 
(about one teaspoonful) and dilute it one-half with al- 
cohol. After treating the wound with iodine it may 
be cleansed with a warm solution of boracic acid. This 
dressing may be left on until the wound has healed, 
or if it is a gaping cut until it can be cared for by a 
physician. The application of hydrogen peroxide to 
a fresh cut (so commonly used) is not a good plan, 
since germs from the surrounding parts may be 
washed into the wound. 

Bruises and Bumps: While these ordinarily do not 
require treatment, if they seem severe, hot or cold 
compresses (changed every five minutes) or a little 
cracked ice wrapped in several thicknesses of cloth, 
may be applied. Witch hazel or alcohol, either of 



EMERGENCIES OF BABYHOOD 135 

which should be diluted, may also be used for a severe 
bruise. 

Burns: There are three degrees of burns, known as 
first, second and third degree. 

A first degree burn is a simple reddening of the 
skin. For this just cover the area with a clean piece 
of linen to which has been applied a little vaseline or 
sweet oil. A cloth wrung from a solution of bicar- 
bonate of soda (baking soda) also makes a comfort- 
able dressing for a simple burn of this kind. 

In a second-degree burn the top layer of the skin 
has been injured and a blister forms. This (in order 
to guard against infection) should be treated like an 
open wound, since the breaking of the blister permits 
the entrance of germs. Cover the area with a clean 
piece of gauze which has been soaked in a solution of 
boracic acid. Leave this on until dressed by a physi- 
cian. Do not apply oil of any kind to a burn of this 
character. 

In a third-degree burn the flesh is actually destroyed. 
This should be treated the same as a second degree 
burn (extra care being used to avoid infection) and no 
matter how small the area it should be treated by a 
physician. 

Colic: This may often be relieved by giving in tea- 
spoon doses every few minutes, one ounce of quite hot 
water into which a soda mint tablet has been dissolved. 
If this does not give relief an enema should be given. 



136 THE CARE OF CHILDREN 

Fractures: In infancy and early childhood broken 
bones seem to cause very little discomfort, except 
when the part is handled, and for this reason a frac- 
ture frequently passes unnoticed. After a child has 
had a fall, if when lifted or undressed he cries out, 
carefully watch him to see if he moves the affected 
part. And if he does not, take him at once to a 
physician. 

Poisons: While a physician should be at once called, 
telling him, if possible, what poison has been taken, 
the child should without any delay be made to vomit. 
This can usually be accomplished by giving some warm 
water to drink, then forcing the index finger low into 
the throat. Syrup of Ipecac (if it happens to be in 
the home), one to two teaspoonfuls, will produce copi- 
ous vomiting. 

Prickly Heat: In summer this is due either to the 
heat or too much clothing. When it appears in winter 
it means always that the baby is too warmly dressed. 
Linen, silk or gauze underwear should be worn next 
the skin and soap should not be used on the inflamed 
area. The discomfort may be relieved by frequent 
sponge baths of starch, bran or bicarbonate of soda. 
(See page 83, Chapter "Baby's Care in Hot 
Weather.") In drying do not rub the skin but just 
pat it gently. The skin should several times a day be 
freely dusted with a powder composed of one ounce 
each of powdered starch and powdered oxide of zinc. 

Eczema: There is no affliction of babyhood more 



EMERGENCIES OF BABYHOOD 137 

annoying or more persistent than eczema. There are 
different forms of the disease and any part of the 
body may be involved. The causes may be either ex- 
ternal or internal. The external causes are always 
some form of irritation such as: Chafing from sud- 
den exposure of the moist skin to the cold air or 
wind, hard water, strong soaps, woolen underclothing, 
lack of proper bathing and negligence in removing 
soiled diapers. 

The internal causes are usually those relating to 
some form of indigestion. In the breast-fed, the 
mother's diet, exercise etc., must be regulated and in 
the bottle-fed the formula must be carefully regu- 
lated to the baby's assimilative ability. In run-about 
children attention must also be given to the diet, 
starchy foods generally being restricted or forbidden. 
Constipation must be looked after in all cases. It is 
most important that scratching and rubbing of the 
parts be prevented. One method of avoiding this in 
infants is a pasteboard splint at the elbow. This pre- 
vents bending the arm while otherwise allowing free 
use of the hands. A powder composed of starch 
and boracic acid, equal parts, will help to allay the 
itching. A child with eczema should always be placed 
under a physician's care. 

Bites of Animals: Apply a dressing and keep it wet 
with a solution of 1-20 carbolic acid, until a physi- 
cian arrives. (For carbolic 1-20 see pages 112-113, 
"How to care for Infectious Diseases in the Home. ,, ) 



CHAPTER XVIII 

IMPORTANT POINTS IN FEEDING DURING THE 
LATTER PART OF THE FIRST YEAR 

By the latter part of the first year a baby begins to 
need food other than milk. Children who are fed 
on an exclusive milk diet after the ninth month are 
always found to be poorly nourished; they are pale, 
cross and irritable, the abdomen is usually prominent 
and the muscles are flabby. And having little resist- 
ance, they are an easy prey to the infectious dis- 
eases. 

While keeping a child too long on a diet of milk 
is a serious fault, it is by no means the most prevalent. 
The greatest number of errors made are : — - 

Feeding too often, giving unsuitable food and lack 
of proper cooking of the suitable foods. 

In beginning with solid foods the first principles 
should be graduation, step by step, supplying the food 
that can be digested and assimilated. The first vari- 
ation toward a diet of solid food should be a small 
quantity of cereal jelly. But this does not mean any 
kind of boxed cereal carrying the directions "Cook 
fifteen minutes." Many of the cereal foods on the 
market are unfit for nursery use, because in the pro- 

138 



IMPORTANT POINTS IN FEEDING 139 

cess of refinement, which renders them attractive, 
much of their nutritious value is lost, especially min- 
eral salts. The best cereal foods are those pre- 
pared from entire wheat, barley or oats. While 
cereals are rich in the constituents necessary for 
muscular development and the production of heat and 
energy, they must, in order to make them nutritious, 
be properly cooked. Otherwise, fermentation is apt 
to take place and cause disturbances. To cook cereals 
successfully one must have a double boiler of agate 
or porcelain. Place the desired quantity of water 
(with a little salt added) in the upper part of the 
boiler; allow this to come in direct contact with the 
heat and when the water has reached the boiling point 
add the cereal slowly, stirring constantly until it begins 
to thicken. Now, it should be placed over the boiling 
water and allowed to cook for a long time, being sure 
the water in the lower part of the boiler does not 
boil dry. Some cereals need longer cooking than 
others. Oatmeal, cracked wheat or barley grain, for 
example, should be cooked at least three hours or 
longer, while such finely ground grains as farina or 
cream of wheat, require only two hours. When 
coarse grain cereals are used, they should for the first 
few months be strained through a colander, thus 
making a cereal jelly. Cereals requiring long cooking 
should always be prepared a day ahead (late after- 
noon or night before), placed in the refrigerator and 
warmed over when needed. 



i 4 o THE CARE OF CHILDREN 

"Why is it necessary to cook cereals such a long 
time?" is a question frequently asked. 

The predominant ingredient in cereals is starch. 
Long cooking at a high temperature is necessary in 
order to break up and set free the starch granules, 
thus making a substance which is more easily digested. 

We have said that the first variation toward a diet 
of solid food should be a small quantity of cereal jelly. 
By the time the child has learned to eat cereals well, 
his system begins to need some food rich in mineral 
elements, especially iron. These may be supplied by 
beef juice, broths, vegetables and milk vegetable soups. 

Vegetables are often a neglected part of a child's 
diet. They are, however, very important, for not 
only are vegetables rich in iron, lime and other valu- 
able salts, but they contain fat, carbohydrates and pro- 
tein. In addition to all the important elements which 
vegetables furnish in supplying the body needs, the 
fibrous material which they contain aids the proper 
action of the bowels. 

Beginning towards the latter part of the first year 
a small portion of green vegetable, thoroughly cooked 
and rubbed through a sieve (in order to break it up 
finely) may be served at least three times a week and 
later on, if well assimilated, once a day. While at 
first only one half teaspoon ful should be given, this 
may be gradually increased up to a level tablespoonful 
at one year. 

While spinach (all varieties) is one of the best vege- 



IMPORTANT POINTS IN FEEDING 141 

tables with which to begin, carrots, asparagus tips, 
string beans, peas, squash, celery, knob celery, oyster 
plant and cauliflower are also suitable, but all must be 
carefully prepared. 

By utilizing the water in which the vegetables are 
cooked, if only in part, the child is given the benefit 
of valuable substances which are extracted from the 
vegetable in cooking. When the child is older, vege- 
tables when cooked until very tender may be served 
without being put through a sieve, merely mashing 
them very finely with a fork and serving simply with 
seasoning and butter. Let us emphasize here that 
vegetables must always be cooked fresh the day they 
are used. Young children are frequently made ill by 
being given warmed over vegetables, left from the day 
before. The same is true of apple sauce and stewed 
prunes, that is, they must be cooked fresh the day 
needed. 

Egg is of essential value in the diet of a growing 
child, since it is rich in mineral matter, containing 
among other things, iron, calcium and phosphorus. 
It is on the other hand an exceedingly rich food and 
must be fed to an infant with care. The egg should 
be very soft boiled, mixed with stale bread crumbs 
and given in the middle of the day. At first only one 
half of an after-dinner coffee spoonful should be given 
and then only every second day. On the intervening 
day a small amount of scraped rare beef mixed with 
stale bread crumbs and moistened with beef juice, 



142 THE CARE OF CHILDREN 

may be given. It is best to wait until the end of the 
first year before beginning with egg. 

About the fifteenth month a baked potato, stewed 
prunes, soft custards and baked apple may be allowed. 
The custards should be made with the minimum amount 
of sugar and the stewed prunes should be squeezed 
through a colander. A baked apple is not only one 
of the most easily digested desserts, but it is also very 
nourishing. When carefully selected and properly 
baked, it should be of the consistency of soft jelly. 
First, peel and core the apple. Then, after placing it 
in a pan which can be covered, add a cupful of water, 
sprinkle lightly with sugar, cover closely and bake in 
a moderate oven until quite tender. This can be 
served with top milk or thinned sweet cream. 

At about the eighteenth month the diet may be en- 
larged to include the heart of a tender lamb chop or 
the white meat of chicken very finely cut. 

In cooking meat for children it is important that it 
should be prepared with care. The juices may be 
retained with their full flavor by plunging the meat 
momentarily into boiling water, thus immediately co- 
agulating the surface albumin. After this it is un- 
necessary to cook meat at an exceedingly high temper- 
ature, in fact, it is much more appetizing and digest- 
ible if cooked at a moderate temperature. 

Many cuts of meat are too tough to be broiled for 
young children, so in order to avoid the connective 
tissue, these should be scraped. Here again care must 



IMPORTANT POINTS IN FEEDING 143 

be exercised, for if meat is pressed firmly together 
it becomes tough and hard. To avoid this the meat 
cakes, lightly held together, should not be pressed be- 
tween the two sides of a wire broiler, but should be put 
on top of the broiler and turned with a knife. Meat 
should at first be given sparingly, gradually increasing 
the quantity and variety during the next month or 
two. 

In addition to orange juice, which may be given at 
the sixth month or earlier, uncooked fruits as an 
early addition to the diet should not be forgotten, since 
they not only offer food elements that are very neces- 
sary but help to regulate the bowels. Many people, 
since they have an idea that raw fruits are difficult to 
digest, refrain from giving them to children. Raw 
fruits are only indigestible when swallowed in hard 
pieces, so until the child has sufficient teeth with which 
to thoroughly masticate, they should be given scraped 
or mashed, care being used to have the fruit ripe but 
not over-ripe. Raw fruit should be given early in the 
day, preferably at breakfast, and not in the middle of 
the afternoon. 

Ordinary breakfast toast should not be given to 
young children. If zwieback is not at hand, from 
bread at least a day old, cut very thin slices and let 
them dry out thoroughly in the oven. This may then 
be lightly toasted if desired. 

The foods mentioned form not only a liberal well- 
balanced diet for the second year, but when enlarged 



144 THE CARE OF CHILDREN 

and varied, they will carry the child well into the third 
year. 

Meals should always be given at regular periods 
and eating between meals should be the exception 
and not the rule. 

There are some children, however, who will not do 
well without some light food, such as a graham bis- 
cuit and cup of broth in the middle of the afternoon. 
Never allow a child to select his own diet — conse- 
quently eating too much of one thing and refusing 
others which are necessary for his health and growth. 

Do not force a child to eat. If within twenty or 
thirty minutes he does not take his food, remove it 
and let him wait until the next meal. If a child has 
every day a good bowel movement, an abundance of 
fresh air and exercise, and when offered only his reg- 
ular meals is not hungry, he has need of a physical 
examination. 



CHAPTER XIX 

DIET SCHEDULES AND FOOD FORMULAS 

While as a rule at nine months of age a baby 
should be getting five feedings of approximately three 
parts of milk and one of cereal water (the milk being 
gradually increased so that the child at one year of 
age will be getting approximately whole milk), nearly 
all children who are strong and vigorous at this time 
require stronger food. For these a diet schedule such 
as given below may be followed : — 

Diet from the Ninth to the Twelfth Month {to be 
Adopted Gradually) 



6 A. M. 



8 A. M. 



10 A. M. 



Milk 



Orange juice 

or 
Pineapple " 

or 
Tomato " 



Cereal 
Milk 



8 oz. 

Either of these should 
be carefully strained and 
diluted with ■ a little 
water. The juice of 
y i oz. stewed prunes may occa- 
sionally be substituted, 
particularly is this ad- 
visable if there is a ten- 
dency to constipation. 

i to 2 Cream of Wheat or Far- 
Tbsps. ina (cooked two hours). 
6 to 8 Give the cereal first, 
oz. pouring over it an ounce 

or two of the milk. 
145 



146 THE CARE OF CHILDREN 

2 p. m. Milk 3 to 4 

and oz. 

Beef- juice 2 to 3 

or Tsps. With stale bread crumbs. 

Broth 2 to 4 (Mutton, chicken or 

or oz. beef) with rice or stale 

bread crumbs. 

Green vege- 3 times In place of the beef 

table weekly juice. 

Begin with one-half tea- 
spoonful, thoroughly 
cooked and rubbed 
through a sieve — in or- 
der to break it up finely. 
The vegetable may, if 
well taken, be gradually 
increased to a level tea- 
spoonful at one year. 
The vegetable must al- 
ways be cooked fresh the 
day used. 

After about two weeks the quantity of beef -juice may be 
gradually increased, until at the end of a month the child is 
getting 6 teaspoonfuls. The maximum quantity up to a year 
should not be more than 3 tablespoonfuls or iy 2 ounces. The 
beef juice should be given one day and the broth the next. 

In preparing the broth, finely chopped vegetables, such as 
carrots, peas, asparagus, or spinach may be cooked with the 
meat, but after the cooking has been completed, all these must 
be strained away, leaving the broth clear. Be sure to skim 
off the fat before serving. 

6 p. M. Cereal 1 to 2 Cream of Wheat or Far- 

Tbsps. ina (cooked two hours). 

Milk 6 to 8 Give the cereal first, 

oz. pouring over it an ounce 
of two of the milk. 

10 p. M. Milk 7 oz. 

Note. — Just as soon as the child is willing to give up the 
10 p. m. feeding and sleep through from 6 p. m. to 6 a. m. 
the 10 p. m. milk should be distributed through the other 
feedings. 



DIET SCHEDULES 



147 



According to all leading authorities, from the 
twelfth to the fifteenth month, a child should be fed 
five meals daily, beginning at 6 a. m. and ending at 
10 P. M. ; from the fifteenth to the eighteenth month, 
four times daily; from the eighteenth to the twenty- 
fourth month, three meals daily, with bread and but- 
ter, a glass of milk, cup of broth or some milk vege- 
table soup in the middle of the afternoon. 

After a child has reached his second year he will 
thrive better if allowed only three meals daily with 
possibly a cup of broth or a graham cracker in the 
middle of the afternoon. 

The five meals schedule (12th to 15th month) could 
be arranged as follows : — 



6 A. M. 



Milk 



8 to 9 
oz. 



8 a. m. Fruit Juice 



Juice of an orange or an 
equal quantity of prune 
juice. 



10 A. M. 


I. Cereal J eily,2 ibsp 




2. Milk 8 oz. 




3. Bread and 
Butter 


2 P. M. 


1. Broth 6 to 8 




or oz. 
Milk Vege- 
table Soup 



(Oatmeal, Wheat or 
Barley) 

Use part of the milk 
over the cereal. 

Zwieback or Graham 
crackers or small slice of 
stale bread and butter. 

Beef, chicken or mut- 
ton, with rice or stale 
bread crumbs. (Do not 
use meat extracts.) 



148 THE CARE OF CHILD.REN 

2 P. m. (cont'd) I to 3 Scraped rare beef, mixed 

tbsps. with bread crumbs and 
or moistened with beef 

Meat juice, 

or 

Egg Soft boiled (begin with 

less than one half) and 
do not give oftener than 
every second day. 

2. Vegetable I tbsp. Green vegetable (put 

through sieve) 

3. Bread and Stale bread or Zwieback 
Butter and butter. 

4. Milk 4 oz. if wanted 

6 p. m. Same as 10 a. m. except cereal may be varied by 
using farina or cream of wheat. 

10 p> m. Milk 6 to 7 

oz. 

From the 15th to the 18th Month 

6 A. m. Milk 9 to 10 

Bread and oz. Stale bread or zwieback 
butter and butter. 

9 a. m. Fruit juice The juice of an orange 

or 3 ounces of prune 
juice. 

10 a. m. Cereal 2 to 3 The best cereals to use 

tbsps. are oatmeal, hominy or 
'(strained) cornmeal (cooked for at 
least three hours in a 
double boiler) or a fine 
grain cereal such as 
Wheatena, Farina or 
Cream of Wheat, cooked 



DIET SCHEDULES 



149 



Milk 

Bread 

Butter 



for two hours. Serve 
with milk and a small 
amount of sugar, or 
with butter and sugar, 
or with butter and salt. 
The dry cereals (Corn 
Flakes, Shredded Wheat 
etc.) may be occasion- 
ally given, but not reg- 
ularly. Twice as much 
must be given as of the 
cooked cereals. 

8 to 10 Stale bread or zwieback 
oz. and butter. 



and 



2 p. M. 1. Broth 



6 to 8 Mutton, chicken or beef, 
oz. into which has been 

stirred rice or stale 
bread crumbs, 
or 
Milk Vege- Scraped beef mixed with 

table Soup bread crumbs and moist- 

or Meat 1 Tbsp. ened with beef juice, or 
minced with white meat 
of chicken 



or 
Egg 



Soft boiled or poached 



2. Vegetable 1 to 2 Green vegetable (put 
tbsps. through a sieve). 



3. Potato 



4. Bread and 
Butter 



2 tbsps. Baked or mashed, or rice 
(boiled two hours in 
double boiler). 

Stale bread buttered 

(whole wheat or white 

Zwieback or Graham 
crackers 



5. Dessert 1 to 2 Custard made with the 
tbsps. minimum amount of 



150 



THE CARE OF CHILDREN 



sugar, junket, cornstarch 
or rice pudding (made 
without raisins) baked 
apple, apple sauce or 
stewed prunes. 

6 P. M. Same as 10 a. m., except the cereal should be 
varied and cooked fruit may be given in addi- 
tion. 

10 P. M. Drink of milk, if wanted. If the child is satis- 

fied without this, the milk should be distributed 
through the other feedings. 

From the i8th to the 24th Month 



6 to 7 a. m. 1. Cereal 



2. Bread and 
Butter 



3. Milk 
10-11 a. m. Fruit Juice 



12.30 P. M. 



Soup 

or 
Meat 



or 
egg 



Cornmeal, oatmeal, hom- 
iny, Cream of Wheat, 
Farina, Wheatena with 
milk and sugar, butter 
and sugar or butter and 
salt. The cereal should 
be cooked the night be- 
fore. 

Stale bread, which may 
be improved by drying 
in the oven or toasting. 
(Do not give hot, fresh 
or fancy breads.) 

Drink of milk. 

Juice of an orange or 
three ounces of prune 
juice 



Puree of lentil, 
beans. 



peas, 



Scraped rare beef or 
finely minced chicken or 
heart of lamb chop finely 
cut. 

Soft boiled or poached. 



niET SCHEDULES 151 

2. Potato Baked, boiled or mashed 

or 

Rice Boiled two hours in 

double boiler. 

3. Green 2 tbsps. Finely mashed (Spin- 
vegetables ach, carrots, asparagus, 

cauliflower, young peas 
or squash, string-beans, 
celery, knob celery and 
oyster plant.) 

4. Dessert 1 to 2 Apple sauce, prune pulp, 

tbsps. baked apple, custard, 
cornstarch, plain rice 
pudding or junket. 

5. Bread and Buttered stale bread, 

Butter plain or toasted. 

3 p. m. Graham cracker, bread and butter or broth — if 
demanded. 

5.30 p. m. 1. Cereal 1 to 3 

tbsps. 

2. Milk 8 to 12 

oz. 

3. Bread and One small slice of zwie- 
Butter back 

4. Cooked fruit 1 tbsp. 
10 p. M. Milk, if wanted 

Diet from the 2nd to the 4th Year 

Breakfast I. Cereal 3 to 4 Give oatmeal, hominy, 

7 a. m. tbsps. cracked wheat, cornmeal 

(cooked at least three 
hours the afternoon be- 
fore) or Farina, Cream 
of Wheat, Wheatena, 
Petti John's or Malt 
Breakfast food (cooked 
for 2 hours). 



152 



THE CARE OF CHILDREN 



2. Milk 
or 
cocoa 



3. Bread 
and 
Butter 



10 a. m. Fruit Juice 



Dinner 
12 noon. 



f Soup 



or 
Meat 



or 
Egg 



2. Fresh 
Vegetables 



and a 
Starchy 
Vegetable 



The cocoa should be 
made by using one tea- 
spoonful of cocoa paste 
to one cup of milk (see 
recipe). 

I to 2 Stale or toasted. Whole 
slices wheat, Graham or White 
bread. 

Juice of an orange or 
four ounces of prune 
juice (unless fruit has 
been given at breakfast). 
Fruit juice may be given 
before breakfast (on 
waking) . 

Milk Vegetable soup, 
strained soups or broths. 



1 to 2 

tbsps. 
or 

2 oz. 



Beefsteak or roast beef 
(rare) or lamb chop, 
chicken or fish. The 
meat should be broiled, 
boiled or roasted, never 
fried. Do not give pork, 
corned beef, veal, kid- 
neys, greasy stews or 
gravy made from grease. 

Soft boiled, poached or 
scrambled with milk 

Such as : Spinach, chard, 
beet tops, greens, peas, 
string beans, squash, 
stewed celery, knob cel- 
ery, oyster plant, cauli- 
flower, stewed carrots, 
asparagus tips and boiled 
onions 



2 tbsps. Such as : Baked, mashed 
or creamed potatoes, 



2 to 3 

tbsps. 



DIET SCHEDULES 



153 



or 
Rice, hominy or maca- 
roni. Do not give cheese 
with 1 the macaroni and 
do not give corn, toma- 
toes, cabbage, fried egg 
plant or cucumbers. 



3. Bread 
and 
Butter 



1 to 2 
Slices 



Stale or toasted. 



4. Dessert 1 to 2 Apple sauce, bakefd apple, 
tbsps. stewed prunes, rice, tapi- 
oca, or bread pudding 
(plain), junket, custard 
or cornstarch pudding. 



Supper 

6 P. M. 



1. Cereal 1 to 2 As described under 

tbsps. breakfast. 

Toast Made from 1 to 2 slices 

of stale bread. 



or 

Milk 



2. Cooked 2 to 3 Or junket, custard, corn- 
Fruit tbsps. starch or plain vanilla 

ice-cream (if these have 
not been given at any 
other meal). 

3. Bread and 1 to 2 Stale or toasted. 
Butter slices 



4. Milker 
Cocoa 



1 cup 



If the child is very hungry, he may have an egg, soft- 
boiled or scrambled (milk) but this should be when he has 
not had egg for breakfast or dinner. 

Too much milk should not be given. One quart a day at 
most is sufficient. Tea, coffee, soda water, wine, cider, etc. 
should never be given. 



154 THE CARE OF CHILDREN 

Recipes and Food Formulas 

Cereal jelly is made by cooking in a double boiler 
for three hours, two ounces of oatmeal, cracked wheat 
or barley grain, in one pint of water, adding sufficient 
water from time to time to take the place of that 
which has steamed away. When the cooking has been 
completed, a thin paste should be formed. While hot 
this should be forced through a colander to remove 
the coarser particles. When cold there is formed a 
semi-solid mass. Cereal jelly should always be pre- 
pared the day before it is required. 

Cereals: Oatmeal, cornmeal or hominy. One cup- 
ful requires about four cupfuls of water. Cook three 
hours in double boiler. 

Rolled Oats: One cupful requires about two cup- 
fuls of water. Cook three hours in double boiler. 
Wheat preparations, such as cream of wheat, wheat- 
ena or farina, require from four to six cupfuls of 
water. They should be cooked in a double boiler for 
two hours. 

To the boiling salted water in the top of the double 
boiler, add the cereal very slowly, stirring steadily. 
Allow it to cook for about five minutes in direct con- 
tact with the heat, then place over the lower part of 
the boiler (which should contain boiling water), and 
allow it to cook for the required number of hours. 

A level teaspoon ful of salt to a cupful of cereal 
will usually be sufficient, but it is well to be sure that 



DIET SCHEDULES 155 

mushes are properly salted, as failure in this respect 
may lead children to dislike them. 

Beef Juice: This is best obtained from the top of 
round steak. After trimming off fat, put in boiler 
and sear on both sides. Then cut into small cubes 
and squeeze out juice by means of meat press or lemon 
squeezers. Salt should be added to taste. 

Broths: Remove the meat from the bone, eliminat- 
ing all fat. Cut into small pieces, then place the meat 
and the bone in a saucepan of cold water (one quart 
to a pound of meat), not including weight of bone. 
Let stand in the cold water for one-half hour. Then 
after bringing to the boiling point, allow it to cook 
slowly for at least three hours. Water should be 
added from time to time, so when the cooking is com- 
pleted there will remain about one half the quantity, 
namely — one pint of broth. Remove the meat and 
bone and when cool remove the fat. The broth should 
then be strained and salt added to taste. Finely 
chopped vegetables may be cooked with the meat, but 
these also must be strained away, when the cooking 
has been completed. 

Scraped Beef: Cut round steak thick and sear 
quickly the outer side over a brisk fire. Then after 
splitting the steak with a sharp knife, scrape the pulp 
from the fibre. This is best accomplished by means 
of a dull instrument such as a spoon. 

Milk Vegetable Soups: These are made from vege- 
tables such as asparagus, peas, beans, lentils, celery, 



156 THE CARE OF CHILDREN 

carrots, spinach, kale or chard, cooked thoroughly and 
put through a sieve, and milk slightly thickened. To 
one cupful of milk use one-half tablespoonful of flour, 
salt and one-third cupful of vegetable which has been 
put through a sieve. Drop the butter in the upper 
part of a double boiler, allow it to bubble (but not boil) 
stir in the flour little by little, then add the milk. When 
this is hot, stir in the vegetable. 

Stewed Prunes: The prunes should be thoroughly 
washed and then soaked over night in cold water. 
Cook in the same water (in which soaked) slowly 
until very soft. When the cooking has been almost 
completed, add a little sugar. 

Twice cooked bread a substitute for zwieback: 
This is prepared by allowing slices cut from stale 
bread to dry out thoroughly in the oven. The oven 
door should be left open while the bread is drying out 
in order that it may not brown. After the slices are 
thoroughly dry they may be lightly toasted, as de^ 
sired. 

Pulling a loaf of bread to pieces is another method, 
having the advantage of making the bread lighter in 
texture. The crusts may be torn off from all but 
the ends of a loaf, in one piece. They should then be 
torn into pieces. For the inside of the loaf, first 
make a small cut in order to start the tearing. Then 
tear first across, afterwards tearing each half into 
about six pieces. Dry out in the oven and then toast 
lightly as needed. 



DIET SCHEDULES 157 

Cocoa: As cocoa contains a great deal of starch, 
it requires thorough cooking and in order to accom- 
plish this without destroying any of the properties of 
the milk, one should first make a stock : To two even 
tablespoon fuls of cocoa, add four teaspoonfuls of 
sugar and one cup of cold water. In adding the cold 
water care should be used to first make a paste with a 
little of the water, mashing all the lumps before adding 
the remainder of the water. Allow this to boil (stir- 
ring constantly to prevent burning) until the mixture 
becomes thick enough to just drop off the spoon. This 
stock can be made up in any quantity desired and kept 
on hand, since if kept in a covered jar in refrigerator, 
it will keep a long time. With the stock already pre- 
pared, all that is necessary for a cup of cocoa is to 
heat a cup of milk until it is just ready to bubble, 
stirring in one teaspoon ful of the cocoa paste. 



CHAPTER XX 

HOW TO COOK VEGETABLES FOR CHILDREN 

In order that the valuable mineral properties may 
as nearly as possible be preserved and that they may be 
easily digested vegetables for young children should 
be very carefully prepared. 

We mention spinach first. This deserves foremost 
consideration, since for young children, spinach is one 
of the very best vegetables, containing as it does 
a high percentage of mineral salts, such as calcium, 
phosphorus and iron. While ordinary spinach is not 
easily available for very long periods, there is on the 
market another variety — a comparative newcomer — 
that may be had throughout the summer. This is 
called New Zealand spinach. Recent experiments in 
the Laboratories of the Rockefeller Institute for Med- 
ical Research and the Babies Hospital, have proven 
that this variety of green vegetable, while not of the 
same family as ordinary spinach, is particularly rich 
in its iron content. In fact of all the vegetables 
tested, such as: Spinach, New Zealand Spinach, 
Young Carrots, Onions, String Beans, Asparagus and 
Potatoes, New Zealand spinach was found to have the 
highest proportion of iron. 

158 



HOW TO COOK VEGETABLES 159 

For a leafy vegetable, such as spinach, the first con- 
sideration is proper cleansing from grit and dirt. 
And this is not as easy as it would seem. The most 
satisfactory way to cleanse any leafy vegetable is to 
wash leaf by leaf under running water. When this 
is not possible it should be washed in a large volume 
of water (using several waters) and should be lifted 
from one vessel to another, since if the water is 
merely poured off, the grit and sand will sink to the 
bottom. When the spinach has been lifted to another 
vessel, care should be exercised to see that no grit 
and sand are left in the bottom of the vessel to which 
it will again be transferred. Until ready to be cooked 
it should stand in cold water. 

There are two methods of cooking green vegetables, 
one by boiling and one by steaming. In connection 
with the test in the Laboratories of the Rockefeller 
Institute for Medical Research and the Babies Hos- 
pital, it was found that in the preservation of the 
mineral salts, steaming was by far the most economical 
method of cooking vegetables. Steaming is accom- 
plished by placing the vegetable in a tightly covered 
receptacle with a finely perforated bottom and fitting 
this closely over the top of a vessel holding boiling 
water. When a steamer is not available, this method 
of cooking may be accomplished by the use of a double 
boiler. Vegetables are prepared as usual, drained and 
placed with no additional water in the inner part of the 
boiler. For cooking them after this manner more 



160 THE CARE OF CHILDREN 

time should be allowed. Spinach requires about thirty 
minutes to cook by steaming. When spinach is boiled, 
a very small amount of slightly salted water should be 
used, just enough to little more than cover the bottom 
of the vessel, since considerable water always clings 
to a leafy vegetable such as spinach and in the process 
of cooking this is soon added to the volume of water. 
When tender, pour over it cold water and drain. The 
spinach should then be chopped very fine and put 
through a coarse seive. Add a small amount of fine 
bread crumbs, made from stale bread, and a little 
butter and salt. Before serving to the child it should 
be reheated. 

Carrots should, to begin with, be young and tender. 
In preparation, they should be scrubbed with a brush 
and washed through several waters. Carrots should 
be cooked in slightly salted water and if before they 
are tender the water cooks away, more should be 
added. When very tender, remove from the water, 
drain and force through a sieve. After adding salt, 
melted butter and bread crumbs, they should, like 
spinach, be reheated before serving. 

Asparagus should be cooked in a small amount of 
slightly salted water until very tender. Then after 
removing the stalks from the water tear the tender 
portion from the stalk by drawing a fork lightly 
through it toward the tip. A sauce should then be 
made by using about two tablespoonfuls of the water 
in which the asparagus was cooked, an equal quantity 



HOW TO COOK VEGETABLES 161 

of milk, a half teaspoonful of flour, salt and butter. 
Mix this sauce with the asparagus pulp. 

Peas should be cooked in salted water until quite 
tender. They should then be drained and for very 
young children should always be rubbed through a 
sieve, since the skins no matter how tender they may 
seem, are very apt to be indigestible. For peas, a sauce 
the same as for asparagus should be made, except 
that fine bread crumbs may be added. This sauce 
should be mixed with the pulp from the peas and be- 
fore serving, reheated. 

String beans when used for children should be 
young and tender and care must be exercised to re- 
move the "strings" which are sometimes attached to 
some species of beans. They should be cooked in 
salted water until sufficiently tender to mash easily 
with a fork. After draining serve with the addition of 
a little salt and melted butter. 

Squash should to begin with be very young and ten- 
der. It should be cooked in slightly salted water until 
tender enough to fall easily to pieces. After drain- 
ing it should be forced through a colander and served 
with salt and butter. 

Only the tender portion of celery should be used for 
young children. This should be cooked slowly in 
slightly salted water until quite tender. After thor- 
ough draining, make a sauce by using a small amount 
of the water in which the celery was cooked and an 
equal quantity of milk, one-half teaspoonful of flour, 



162 THE CARE OF CHILD.REN 

salt and butter. This should be mixed with the finely 
mashed celery. 

Cauliflower after it has been broken up and thor- 
oughly washed should be cooked uncovered in a large 
amount of water. This vegetable requires about a 
quart of water to each head of cauliflower. The water 
should be salted and should be boiling when the cauli- 
flower is added. When tender it should be drained 
and forced through a coarse sieve. Serve with a sauce 
made from equal quantities of milk and water (using 
the water in which the cauliflower was cooked) salt, 
flour and butter. 

Boiled onions may be added to the diet after the 
third year. At this age it is no longer necessary to 
put any of the vegetables through a colander, with the 
possible exception of peas, the skins of which may dis- 
agree with some children. Cooking until tender and 
mashing with a fork is usually sufficient. 

If the supply of fresh green vegetables is not plenti- 
ful, the water or juices in which they are cooked 
should always be saved. This may be utilized partly 
in preparing a sauce for those vegetables served in 
this way and partly in preparation of creamed soups, 
using for this purpose the vegetable stock in equal 
quantities with milk. 

In utilizing the water in which the vegetables are 
boiled, it should always be remembered that this con- 
tains valuable vitamines, which in the process of cook- 
ing have been extracted from the vegetable. Vita- 



HOW TO COOK VEGETABLES 163 

mines are what may for a better term be called "mys- 
terious food elements." They are, so far as is known, 
apparently not food elements themselves, but are neces- 
sary for the utilization of food. 



CHAPTER XXI 

COLDS A SERIOUS MENACE 

A wise saying of the ancients was, "Obesta prin- 
cipiis" (Prevent the beginning). Nowhere is this 
more applicable than to the common colds of childhood. 

Do not underestimate colds. They are the greatest 
enemy of vitality. Next to intestinal disturbances, in- 
flammation of the air-passages due to colds is the 
greatest menace to the health of infants and children. 

Every cold in a young child should be seriously con- 
sidered and an effort made to combat it. Aside from 
the immediate debility, an acute cold opens the way for 
the entrance of more serious disease. There is a pos- 
sibility of such complications as bronchitis, pneumonia, 
middle ear infection and tonsilitis. Also frequent colds 
and throat affections are likely to cause enlargement 
of the glands of the neck and these may become in- 
fected with the tubercular bacillus. 

The first step in the prevention of a cold is to as- 
certain if the child is breathing properly. Proper 
breathing can not be effected if there is pressure from 
adenoids and greatly enlarged tonsils. If there is any 
abnormality of the nasal membrane or of the nose, it 

should be corrected. 

164 



COLDS— A SERIOUS MENACE 165 

Most colds are infectious and are transmitted 
through contact. If we were not so careless about 
them, they would not be so common and apparently so 
unavoidable. 

As young children are very susceptible, it is wrong 
that they should be exposed by taking them into 
crowded cars, stores or places of large assemblage 
where it is impossible to avoid contact with coughing 
and sneezing people. Their susceptibility can be more 
readily understood when we take into consideration the 
fact that the blood of a child is not equipped with 
the same fighting power as that of the adult. Chil- 
dren have fewer red blood-corpuscles, making them 
prone to anaemia, and while the white blood corpuscles 
are more numerous, relatively few of them have germ- 
icidal power. 

If properly clothed, the outdoor air does not predis- 
pose a child to a cold as much as the indoor air. Of 
course chilling, whether indoor or outdoor, will predis- 
pose to a cold. 

The habit of leaving the robes out in the carriage 
and then using them without warming is a fruitful 
source of colds for young children. When these thor- 
oughly chilled robes are placed about the child, they 
do not become comfortably warm until he has imparted 
to them considerable heat from his body, which is a 
drain upon his vitality. 

When going out on a cold, windy day, the ears of 
young children should be protected from exposure to 



166 THE CARE OF CHILDREN 

cold winds. The mother should always be on the alert 
to see that the sleeping child is not placed in a position 
where a pronounced and direct draft will strike him. 

The feet of young children should be well protected 
by substantial shoes, and, when there is thawing snow, 
by rubbers, as melting snow is very penetrating. 

Try to keep the feet warm, for if they remain cold 
for any length of time, the blood vessels contract, and 
the flow of blood which should be in the lower ex- 
tremities is sent to the head and other parts of the 
body. This makes an uneven distribution of the cir- 
culation and a condition of lowered vitality which in- 
vites the entrance of germs, causing inflammation of 
the air-passages. 

Overheating is a common cause for the development 
of colds in children. When a room is overheated, 
there is not enough moisture left in the air. By the 
constant breathing of this air, the mucous membranes 
become too dry, thus causing an irritation or con- 
gestion of the nostrils, and the least irritant that may 
come in contact with the mucous membrane may cause 
at least a simple inflammation. This congested area 
may then at any time pick up and harbor or cease to 
kill germs. 

It is important to remember that the heat production 
in a child is very active and his need for oxygen much 
greater than in the adult. The mother should not 
depend upon her own sensations as a guide to the qual- 



COLDS—A SERIOUS MENACE 167 

ities of the atmosphere, especially if she is of seden- 
tary habits. 

When the weather is so cold that a comfortable 
temperature can not be maintained with the windows 
open, outside air should be occasionally admitted by 
opening wide the windows and airing the room for 
a few minutes. In very severe weather it is a good 
plan to air the nursery whenever the baby is taken 
into another room. An open grate in the room is 
very desirable, not only because it permits of extra 
heat when necessary, but because it helps to keep the 
air in the room in circulation. 

Young children who are accustomed to fresh air 
from early infancy, and who are fed properly, are 
much less liable to colds. 

Every mother should bear in mind that the appear- 
ance of a cold demands careful attention, not only 
because it may develop into some of the respiratory 
diseases, but because certain contagious diseases appear 
first as a cold in the head. 



CHAPTER XXII 

GUARDING BABY'S EARS 

It is a sad fact that over thirty per cent, of the 
inmates of our institutions for the deaf are children 
who have an acquired deafness, which, if taken in time, 
might have been prevented. In addition to this fact, 
physicians are constantly coming in contact with large 
numbers of adults suffering from a hopeless progres- 
sive deafness, which undoubtedly could have been pre- 
vented, if during early childhood, when some inter- 
current infection or one of the infectious diseases 
started the trouble, they had received proper care. 

The organ of hearing is a most delicate piece of 
mechanism, quite easily getting out of adjustment. 
This is especially true of infants and children up to 
the age of five years. 

Middle ear inflammation is at the root of most cases 
of deafness. So assailable is the middle ear of in- 
fants, sometimes the mere cutting of a tooth, intestinal 
disturbance or an attack of tonsilitis may be the cause 
of serious middle ear infection. 

The pfrevention of acquired deafness rests upon: — 

The care of the ears after the acute infectious dis- 
eases and after acute febrile disturbances 

168 



GUARDING BABY'S EARS 169 

The care of the teeth and the removal of diseased ton- 
sils and adenoids 
Prophylaxis of the nose and throat 
The careful testing of children's ears 

Of all the affections of childhood, the contagious 
diseases, particularly scarlet fever, measles and menin- 
gitis, are most destructive to the ear. Many deaf 
mutes and a large proportion of people partially deaf 
owe their disability to one of these diseases. Middle 
ear infection may also follow diphtheria, grippe, 
whooping-cough and typhoid fever. Any ear infec- 
tion occurring after grippe is especially to be feared, 
as the virulence of the infecting germs may result in 
mastoiditis. 

We have said that of all the affections of childhood, 
scarlet fever, measles and meningitis were most de- 
structive to the ears. The histories of progressive 
deafness taken by physicians reveal the fact that in 
the majority of cases the trouble began in childhood 
during or after one of these diseases. And does this 
mean that during the illness the ears were neglected? 

By no means. It means, in most instances that 
during the acute stages of the disease the ears have 
been cared for and remedial measures used. But after 
the acute stage when the inflammation has subsided and 
the suppuration ceased, the slight defect of hearing 
has passed unnoticed. This is particularly true of 
scarlet fever and measles. For with these there is 
often some remaining process left by the disease 



lyo THE CARE OF CHILDREN 

(some local trouble) which, when uncared for, leads 
to impairment of hearing in later life. In other 
words, much progressive adult deafness results from 
the neglect of local trouble in childhood following one 
of these diseases. After recovery from measles or 
scarlet fever, children should be taken to an ear spe- 
cialist in order that any defect in hearing may be de- 
tected and remedial measures used in an effort to 
bring it again to normal. 

Bad teeth, adenoids, enlarged and diseased tonsils 
are predisposing causes of ear infections. They har- 
bor innumerable disease germs, causing inflammation 
and constant irritation to the mucous membrane of 
the nose and throat. And since the middle ear of in- 
fants is separated from the nose only by a short wide 
tube, it is easy to see how this infectious material 
may by violent coughing and sneezing be forced into 
the ear. It must also be remembered that the tonsils 
are in close proximity to the Eustachian tubes (canal 
running from the middle ear cavity to the pharynx) 
and from direct pressure on these may cause impair- 
ment of hearing. Diseased tonsils and adenoids are 
responsible for many of the ear complaints of early 
childhood which lead in later life to deafness. For 
this reason when a child begins to show signs of ear 
trouble he should be examined by a physician for pos- 
sible adenoid growths and diseased tonsils. While 
the concensus of medical opinion favors leaving the 
tonsils (unless there is evidence of impaired hearing) 



GUARDING BABY'S EARS 171 

until the end of the second year, if adenoids are pres- 
ent, they should, no matter what the age of the child, 
be removed. 

The acuteness of a child's hearing depends upon the 
normal balance in the middle ear. This balance is 
maintained only when the tubal muscles are at proper 
tension, thus automatically, with each act of swallow- 
ing, massaging the drum and the small bones of the 
ear. And what are the factors interfering with this 
normal balance? 

An unclean condition of the nose and throat. In 
other words, an accumulation of mucus tending to 
an engorgement of the Eustachian tubes (canal run- 
ning from middle ear cavity to pharnyx). The child's 
nose should be cleansed as a part of the daily toilet 
and as soon as the growing intelligence permits, he 
should be taught how to properly blow the nose. For 
this :— 

Tell the child to take a deep breath (filling the chest 
with air) then by placing one finger upon the outside of 
the nostril, thus obstructing the passage, with a violent 
expiration force the air from the chest through the 
open chamber of the nose, thus removing the offending 
discharge onto the handkerchief. The same process 
should then be repeated on the opposite side. If, when 
blowing the nose in this manner, air is felt to force 
itself into the ear, the nostrils should not then be held. 
While it is a simple matter when the child's health is 
up to par to keep the nose and throat clean, if from 



172 THE CARE OF CHILDREN 

any condition such as rickets, marasmus, malnutri- 
tion or devitalizing diseases, his vitality has become 
lowered, this is much more difficult, since such a child 
is more prone to troubles in the upper air passages. 
Children of this class should be placed under the care 
of a physician, not only that the health may be brought 
up to par but that he may advise some local treat- 
ment for keeping the nose and throat clean. 

During early child life, the hearing should be vari- 
ously tested. One way of accomplishing this is to 
speak to the child from an ordinary distance, saying 
something that he would be interested in hearing, 
using a tone of voice a little lower than usual. If 
there has been any acute condition of the nose and 
throat or of the ear itself, the child should, in order 
that hearing tests may be thoroughly made, be taken to 
a physician. Likewise, a child slow in learning to 
talk should have a thorough examination. For fre- 
quently this is due to the fact that he does not hear 
well. Many a child thought to be backward in his 
school work is not really stupid, but loses interest in 
his studies because it is a great effort for him to 
hear. 

Earache is usually the first danger signal of ear 
trouble. While many parents accept this as a nec- 
essary evil, earache is really a symptom of an active 
and perhaps serious infection and calls for instant 
attention. Convulsions in babies are thought to be 
paused more often by earache than any other cause. 



GUARDING BABY'S EARS 173 

This is due to irritation of the brain membranes. 
And now let us go a little further into the reasons as 
to why earache or any condition affecting the ear 
should not be neglected. 

When the middle ear becomes infected its various 
compartments, including the mastoid cells, are soon 
filled with a serum or pus. This broken-down mate- 
rial in seeking an exit presses against the drum-head, 
causing earache. As the drum-head of an infant is 
frail it usually yields to this pressure and breaks and 
the ear begins to discharge. Now right here is often 
the beginning of life-long trouble. For quite fre- 
quently such advice as "leave it alone, he will outgrow 
it" is given to mothers. This course is erroneous 
and dangerous. It is right that the pus and infected 
material should drain from the ear but the child should 
be under the care of a physician during this time. 
Here are some of the things which are liable to 
happen : 

First. Drainage may not be free enough, in which 
case the child would continue to have pain. 

Second. There is danger of reinfection and the ear 
may discharge indefinitely, which is almost sure 
to mean impaired hearing. 

Third. The perforation may heal without the cause 
of the inflammation having been removed, thus 
other attacks might follow until the condition be- 
came chronic, during which periods the ear-drum 
may become thickened, causing in time either par- 
tial or total deafness. 

Fourth. If the healing process should take place be- 



174 THE CARE 0F CHILDREN 

fore the ear has properly drained, still leaving a 
focus of infection, there is sure to be another at- 
tack with the resulting pus and exudate again 
pressing against the ear-drum, but the healing of 
the first perforation has naturally left scar tissue 
so the ear-drum may not give way as easily as it 
did the first time. 

What happens then ? 

All this broken down material which is trying to get 
out must seek another exit. This it usually does 
through the mastoid cells. In this case the inflamma- 
tion develops into mastoiditis which means at the 
least a serious operation. 

Should the doctor order the discharging ear to be 
irrigated for the purpose of cleansing the canal, this 
should be very carefully done. The tip of the 
syringe should be very small. The glass part of a 
medicine dropper makes an excellent tip for this pur- 
pose. If there is not anything better at hand this 
can be attached to an ordinary douche bag. But simply 
squirting water at the ear with the tip an inch or 
more away from the auricle will not bring success. 
The ear to be treated should be in a good light. The 
bag should be suspended not more than two feet above 
the ear in order to allow a gentle flow with but little 
force. Then with the left hand draw the lobe of the 
ear upward and backward — in order to straighten the 
canal — while with the right hand introduce the tip of 
the syringe slightly into the canal, pointing the nozzle 
upward so the fluid will flow over the drum-head and 



GUARDING BABY'S EARS 1175 

not directly against it. The tip of the syringe should 
be held lightly in the fingers in order that it may be 
quickly withdrawn upon the slightest movement. A 
kidney shaped basin protected by a towel should be held 
by a second person close to the neck and just under 
the ear. An ordinary fountain syringe with small 
black rubber tip may also be used for irrigating the 
ear. 

After an irrigation, the canal of the ear should be 
dried with sterile cotton. 

For several weeks after an attack of middle ear in- 
fection, extra precautions should be taken against ex- 
posing the child's ears to cold air and wind. When 
he is taken out, dry cotton should be placed in the ears ; 
this should, however, be removed as soon as he reaches 
home, for if left longer than a few hours, it will cause 
irritation and will also produce an unnatural amount 
of heat. 

A beginning ear infection can frequently be aborted 
by the use of dry heat externally in some form, such 
as a hot water bag, salt bag or hot flannels. It is per- 
fectly safe to use either of these while waiting for the 
arrival of the physician. 

The ear in health requires simple cleanliness, such 
as washing the external ear with a soft rag and care- 
fully drying it as well as the creases back of the ear. 
Never attempt to clean the ear canal by the use of 
matches, tooth picks or hair pins used as probes for 
digging out wax. Wax is provided by nature to keep 



176 THE CARE OF CHILD.REN 

the inside of the ear in good condition and its re- 
moval is provided for normally by the action of the 
lower jaw during mastication. So do not attempt to 
remove any wax except that which has passed into the 
outer ear and can be reached by a damp cloth stretched 
over the tip of the little finger. 



CHAPTER XXIII 

CHILDREN'S TEETH EVEN THE BABY ONES 

SHOULD HAVE THE UTMOST ATTENTION 

It is now universally conceded that the most con- 
spicuous defect of the school child is decayed teeth. 
In fact, this imperfection generally outranks all other 
defects combined. One of the recent reports from the 
Division of Dental Hygiene, Department of Health of 
a Connecticut city, states that it is difficult to find two 
school children out of a hundred with, a sound set of 
teeth, that the average is seven cavities per child and 
that of all children examined within the past five years 
malocclusion (abnormal closing of the upper upon 
the lower teeth) was present in ninety-eight per cent. 
And what does this mean? 

It means that while practically every branch of med- 
ical science has brought forward the fact that greatly 
varying and sometimes serious or fatal systemic 
diseases are due to oral infection and oral disease ; that 
while the student of mental deficiency and the educa- 
tor have called attention to the dental anomalies and 
anomalies of the dental arches, etc., in mental deficiency 
and other conditions; it means that while all have re- 
peatedly shown that the value of thirty-two sound teeth 

177 



178 THE CARE OF CHILDREN 

in normal position cannot be measured, there is still 
a world-wide lack of knowledge as to the relation of 
sound teeth to good health. 

Dental clinics in connection with the public schools 
have had a marked effect in promoting the health of 
school children. They have not only increased the 
average attendance at school — since eighty per cent, of 
absences in the third, fourth and fifth grades are due 
directly or indirectly to toothache — but have in many 
instances reduced as much as fifty per cent, the condi- 
tion of retardation among pupils. And yet both 
the medical and dental world are now emphasizing 
the fact that without attacking the trouble at its source, 
the work of the dental clinic in connection with the 
school is merely palliative. In other words, dental 
decay, like other disease conditions, is due to certain 
known causes, and the way to mitigate the evil is not 
alone in repairing the damages as they occur, but in 
preventing them. Physicians in private practice have 
repeatedly proven that from eighty to ninety per cent, 
of dental caries, commonly known as dental decay, can 
be prevented. 

Few of us realize the significant fact that if a child 
can be brought to the age of fifteen or sixteen with 
sound teeth in normal occlusion, he will very likely go 
through life without any serious dental defects. For 
not only has he established the habit of keeping them 
clean and using them prudently, but the teeth them- 
selves, due to this care, will have acquired a density 



CHILDREN'S TEETH 179 

and firmness, which will render them more capable of 
resistance to the ordinary causes of decay. 

Sound and healthy teeth in adult life depend upon 
four main principles : 

Diet in infancy and childhood 
Prevention of pernicious habits in infancy 
Care of the deciduous teeth 
Care of the teeth during the early school life 

First, we must bear in mind that each tiny tooth of 
both the deciduous and permanent sets are embedded, 
or partly so, in a cavity of the jaw bone, even at 
birth. The teeth develop and grow with the body. 
Usually, at about the seventh month of life, one 
group is ready to cut through the gums; other teeth 
coming through at different intervals until the child 
is two and a half years of age when, if development 
has been along normal lines, he should have the entire 
set which consists of twenty teeth. 

The diet during the first nine months of life has a 
marked effect on the growing and developing teeth. 
Statistics gathered within the last few years by the 
Departments of Health of various cities, after exam- 
ination of the teeth of thousands of children, and tab- 
ulating the diet in infancy, have emphasized some 
significant facts: — 

First. That breast-fed babies stand the best chance 
of developing strong and beautiful teeth. 

Second. That babies fed on a properly modified 
cow's milk with the early addition of orange juice 



180 THE CARE OF CHILDREN 

(supplying in particular mineral matter) stand the 
next best chance. 
Third. That a diet in which some of the essential 
constituents are lacking, that is, one high in carbo- 
hydrates and low in fat, protein and mineral mat- 
ter (as is the case with condensed milk when used 
alone) given during the period of infancy when 
the teeth are developing and calcifying, affects 
their development and subsequent soundness. In 
other words a poorly balanced diet in infancy ren- 
ders the teeth more susceptible to decay in later 
life. 

The child should not be kept too long on soft foods 
for the vigorous exercise of biting and chewing is 
essential not only for the development and health of 
the teeth but for enlarging and strengthening the jaws. 

At the end of the first year more or less dry, hard 
foods should be daily introduced into the diet. Begin 
by giving zwieback, dry, hard toast or crust at the 
end of the meal, adding from time to time strips of 
tough meat and bacon rind, from which the child may 
chew the juice. Later as he grows older fresh fruits 
and vegetables, such as apples, grapes, celery, radishes 
and green salads may be added. Such foods as these 
not only exercise the teeth but cleanse and polish them. 
As acid fruits produce a highly alkaline saliva, they, 
rather than sweets, are an ideal food with which to 
finish the meal. That is, the resulting flow of highly 
alkaline saliva (when fruit is taken at the end of the 
meal) counteracts the high acid potentiality of sweets 
and starches which is so harmful to the teeth. 



CHILDREN'S TEETH 181 

Such pernicious habits as thumb sucking and the use 
of the "pacifier" are a cause for deformity and irreg- 
ular teeth. They tend first of all to cause abrasion of 
the oral mucous membrane and to deform the mouth. 
The constant suction is liable not only to deform the 
developing alveolar ridges, but to cause a narrowing 
of the palatal (palate) arch, and to thrust the upper 
jaw forward, thus causing the jaws not to bear the 
proper relation to each other and, consequently, the 
teeth not to meet correctly. 

As soon as the first molars come through, which is 
usually from the twelfth to the fifteenth month, the 
baby's teeth should be gently cleansed each day with a 
soft brush, care being taken not to injure the delicate 
tissues, and thereafter they should be carefully watched 
for signs of decay. As the baby grows into child- 
hood, he should be taught the daily care of his teeth. 
It is important that the baby teeth should not be lost 
or extracted prematurely. This may cause deformity 
of the soft, easily moulded jaw and it certainly permits 
shrinking and warping, leaving insufficient room for 
the new and larger teeth, thus causing them to be 
crowded and pushed forward. Many physicians and 
dentists believe that premature extractions by reducing 
the diameter of the anterior nares (nostrils) may pre- 
vent normal nasal breathing. 

When a child shows even the slightest abnormality 
of the jaws or irregularities of the teeth, he should at 
once be placed in the hands of a skilled dentist. For 



182 THE CARE OF CHILDREN 

these are deviations that may easily be corrected while 
the bones are soft and pliable, that is, during the first 
few years of dentition, but, if neglected, may result 
in an exaggerated deformity of the face or jaw. In- 
deed such deviations, at first appearing as only trivial, 
often result in a high palatal arch with abnormality 
of the nasal septum, producing nasal deformity. 

Beginning about the sixth year, the first set of teeth 
are gradually replaced by the second. If at this time, 
as often happens, the milk or deciduous te'eth show no 
tendency to come out, the child should be taken to 
the dentist, for should the first teeth be allowed to re- 
main in the jaw beyond their time, they will crow*d 
back the second and cause them to be misshaped and 
irregular. Irregular teeth, in addition to impairing 
one's good looks, render the thorough cleansing of 
the mouth very difficult, thus offering greater oppor- 
tunity for the formation of cavities. 

That decay of the teeth is easily induced and is most 
rapid between the ages of six and fifteen has been 
proven time and again by the examination of the teeth 
of thousands of school children. While this may to 
some extent be due to the fact that the most rapid 
body growth takes place between these periods and 
that many children do not get in their food sufficient 
lime salts to meet the demands of the developing 
teeth and bones, we may also put it down as an axiom 
that a clean tooth never decays. And here it may 



CHILDREN'S TEETH 183 

not be amiss to state the initial cause of dental caries. 

The teeth, as we know, are protected by a hard 
covering of glossy enamel. This is their armor of 
health and as long as it remains unbroken they do not 
decay. Now how does an unclean mouth affect this 
enamel ? 

We know there is no known way of keeping the 
mouth free from harmful bacteria. But it is not bac- 
teria alone which cause the teeth to decay; the trouble 
is produced by the sticky starches, sweets and other 
food residue which is allowed to remain between the 
fissures of the teeth after meals, most especially during 
the long period from supper to breakfast. Certain of 
these bacteria, due to the heat and moisture of the 
mouth, cause rapid putrefaction of these food rem- 
nants forming acids which are injurious to the enamel. 
In other words, the initial cause of dental caries is the 
action of the bacteria in the mouth on the sugars and 
starches, reducing them to lactic acid. The lactic acid 
not only affects certain elements which make up the 
enamel but it precipitates from the saliva upon the 
teeth the mucin (a glutinous fluid secreted from the 
mucous membranes), thus forming a glue-like sub- 
stance (called a placque) which acts as a protection 
for the micro-organisms and the fermenting car- 
bohydrates. When this placque is allowed to remain 
on the teeth for long periods, the enamel either breaks, 
becomes moth eaten or so impaired as to allow the 



1 84 THE CARE OF CHILDREN 

entrance of bacteria to the softer parts of the teeth. 
After the enamel is pierced and pits appear, unless 
checked, the destruction of the tooth is rapid. Now 
this brings us back to the statement — that a clean 
tooth does not decay and if the teeth are to be saved 
it must be during the growing period, particularly 
during school life. How is this to be done? 

Simply by instilling early into the minds of the 
children the absolute necessity of oral cleanliness, in 
order that the habit may become a part of their daily 
lives. So begin early. See that the children's teeth 
are properly brushed each day, after meals and most 
especially at bed time. Merely rubbing the brush back 
and forth across the front teeth, as is the habit with 
some children, does not constitute cleansing them. 
The brush must be rubbed over the inner, outer and 
biting surface of all the teeth. A good method is to 
clean the molars first, then the front teeth, using a 
gentle circular motion, not forgetting the back # of the 
teeth. 

A small tooth-brush of medium hardness should be 
employed for children and the dentifrice should be 
something very simple, preferably a liquid. After 
use, the tooth-brush should be carefully washed and 
placed in a solution of fifty per cent, alcohol or in 
a weak solution of formalin ( 1-20) in a long, closed 
tube. For if left open in a glass or on a shelf, there 
are gathered into the crevices of the wet bristles, bac- 
teria from the air, and these are introduced into the 



CHILDREN'S TEETH 185 

mouth the next time the teeth are brushed. So while 
teaching the child the care of the teeth, teach him also 
the care of the brush. 

Habits of personal hygiene are easily fixed in youth. 
There is no habit more important than the care of the 
teeth, for a clean mouth with sound teeth is the one 
most important factor in the prevention of disease. 



CHAPTER XXIV 

THE CARE OF CHILDREN^ FEET 

Most of the distressing foot troubles which bother 
people to-day could have been prevented by giving the 
feet attention in childhood. The care of a child's 
feet should in fact begin as soon as he has learned to 
walk. Most children, indeed, especially those who are 
heavy, need moderate restraint rather than encour- 
agement in their efforts at standing and walking. For 
at this age not only are the bones pliable, but the 
muscles and ligaments are at first lacking in strength. 
This strength is gained by use, but such use should 
come about gradually. 

In the hygiene of the feet there are two essentials: 
First, correct posture ; second, correct dress. The bony 
skeleton supports the body weight and the feet are the 
base of that framework, so they support all the super- 
structure. And as each bone in the skeleton joins 
another bone, producing a joint held together by 
muscles and ligaments the feet as the basis of it all 
have an important bearing on the general poise and 
posture of the body. 

As the muscles and ligaments maintain the body 

balance, any abnormal deviation of the feet in weight 

186 



THE CARE OF CHILDREN'S FEET 187 

bearing may result not only in weak foot or flatfoot, 
but may seriously impair the health because of lack of 
body balance. In children this may lead to drop 
shoulder, spinal deformities, backache, headache and 
nervousness. It is often a cause of backwardness at 
school, the "all-ti red-out" feeling and loss of appetite. 

This brings us to the question : What is the correct 
position of the feet in walking or standing? The 
normal position of the feet in bearing the weight of 
the body is with the toes pointing straight forward. 
In this position one can step squarely upon the foot, 
the weight of the body is equally distributed, the feet 
have their greatest elasticity and the arches can per- 
form their full function without strain. The "straight 
foot" is the ideal. It is deviations from this that 
usually start the child on the road to some foot dis- 
tortion in adult life. 

"I have watched carefully," says an orthopedist, 
"and so far have never come across a patient suffering 
from flatfoot who habitually stood and walked with 
the feet nearly parallel." By experiment every mother 
should convince herself that the "straight foot" is, in 
weight bearing, the position of strength, and so aim to 
have her children walk and stand correctly. 

For experiment, after removing the shoes stand 
with the toes turned outward at an angle of about 
forty-five degrees. What do we then observe? 

First, the weight is inclined toward the inner side 
of the sole of the foot; that is, it comes to the inner 



1 88 THE CARE OF CHILDREN 

side of the center of balance. Second, the heel is 
tilted inward, the arch downward,and the heel does 
not come within the axis of the leg. Third, the ankle 
bone and that portion of the foot immediately be- 
neath it tend to bulge. Fourth the rotation of the 
leg, which takes place when the feet are turned out- 
ward, puts a strain on its muscles which can be felt 
distinctly at the knee. 

Now consider these points. What do we find? 
Simply, that any one of them, when exaggerated (as 
in time is the case) leads to trouble. Taken collect- 
ively, they result in the formation of a vicious circle, 
to the detriment of the whole body. 

Now stand with the feet parallel. What do we note ? 
First, the entire foot is brought into use. Second, 
the body weight is distributed throughout the foot 
without undue pressure on any one point. Third, 
the ankles return to their normal curve and the bones 
lose their tendency to protrude. Fourth, while 
standing with the feet parallel there are no muscles 
on strain and, without conscious effort, one cannot 
assume the position of "weak foot." These points 
make it plain that nature intended that we should walk 
with our feet parallel, toes pointing forward. 

While making the experiment, stand also with the 
feet in the position of "pigeon toe" — that is, with the 
toes "turned in." What do we notice? First, the 
arch of the foot assumes a higher curve. Second, 
most of the weight is thrown to the outer side of the 



THE CARE OF CHILDREN'S FEET 189 

foot. Third, the muscles of the legs are put on strain. 

Just as bad as "toeing out," one may say. But 
this is a mistake. While the "pigeon toe" position in 
weight bearing is not a graceful one, and while the 
natural balance of the body is unquestionably dis- 
turbed, it does not weaken the structures of the foot 
or lead to "weak foot." The reason for this is in the 
construction of the foot, the inner side of the arch 
which crosses the foot being less strongly supported 
by muscles and ligaments than the outer side. 

We have seen from the experiments that the whole 
of foot training is to have the foot in weight bearing 
rest squarely on the ground. The next question is: 
How are we to prevent abnormal deviations of the 
feet? 

Given a normal foot, this prevention is accomplished 
by correcting wrong habits of muscular action in the 
posture of the feet while the muscular system is im- 
mature. Begin by correcting at once any tendency 
to develop the wrong position of the feet. If the 
child tends toward the outflared position, have him 
practice walking a straight line ; offer a prize for walk- 
ing with the feet parallel, toes pointing forward. 
Above all, do not weary in the training. For, com- 
pared with the benefits to health from normal weight 
bearing, the trouble is a small matter. 

While home training can accomplish wonders, there 
are some abnormalities which without mechanical ap- 
pliance no amount of home training can change. There 



190 THE CARE OF CHILDREN 

are clubfoot, knock-knee, hammertoe, and so on. 
Sometimes the extreme "pigeon-toe" position requires 
special work on the child's shoes, such as pigeon-toe 
tips on the outer side, which tend to cause the child 
to toe straight. 

These are problems for the orthopedic physician, 
not for the shoe salesman or the chiropodist. Do not 
make this mistake. For all too often it means not 
only loss of time and money, but, what is more serious, 
allowing the time for cure to pass. All such abnor- 
malities should be attended to before the bones have 
become hardened and the muscular system too mature. 
It is after the sixth year that the child begins to attain 
the adult type of foot. 

Shoes have a great deal to do with the posture of 
the rest of the body as well as of the feet themselves. 
When a child first begins to wear shoes, the fundamen- 
tal consideration is that ample room be given for the 
free play of all the muscles. For if the muscles are 
bound up and weakened by strangulation, it stands to 
reason that the arch, which is supported by the muscles, 
must suffer. For this reason it is a mistake to restrict 
the muscles at the ankle by a stiff high shoe in which 
are incorporated either stiff counters or whalebone. 
The moccasin is the ideal shoe with which 
to begin. 

When selecting shoes for young children, they should 
be carefully inspected, for in the formative period the 
feet are easily pressed out of shape. What are the 



THE CARE OF CHILDREN'S FEET 191 

principal errors against which we should guard? 
First, be sure the shoes are broad enough across the 
toes and that they are sufficiently long. In the normal, 
unspoiled foot — that is, one which has not been 
cramped — the toes stand apart and the great toe is on 
a straight line with the inner side of the foot. What 
happens when the shoe is too narrow? 

The small toes being the weaker are crushed to- 
gether until their natural symme!try is lost. This 
causes discomfort and in trying to lessen this the 
weight is consciously or unconsciously thrown to the 
inner side, causing pressure on the great toe, the 
first two bones of which are forced inward. As a 
result of this the normal straight line of the great toe 
is gradually obliterated ; we find it curved inward, press- 
ing against the second toe. This condition lays the 
foundation for a bunion. For in its beginning a bun- 
ion is not an overgrowth of bone, but a partial dis- 
location at the joint. 

The shoe which is too short causes corns on top of 
the toes. When the toes are pushed backward the 
ends curl under. This naturally pushes the other part 
of the toe upward and undue pressure at this point 
causes a corn. 

Inspection of the worn shoes is a valuable guide to 
the condition of a child's feet. What are some signifi- 
cant signs? If the upper of the shoe is distorted — 
that is, if the median line leans toward the inner side 
or if the heel and sole are worn down on the inner side 



192 THE CARE OF CHILDREN 

— this is an indication of "weak foot." A shoe badly 
worn on the outer side of the sole shows a tendency 
to weak ankle. This would be an indication for a 
broad heel and extension sole. The shoes should be 
low so as to allow the muscles plenty of room for 
development. 

If the great toe has forced a cavity or an opening 
into the toe of the shoe, it is too short. If the toe 
of the shoe is unusually worn, while the other parts 
are hardly affected, it generally means a shortened heel 
cord or a weakness of the muscles of the foot, per- 
mitting what is known as "toe drop." A shortened 
heel cord prevents the heel from coming down prop- 
erly. It can be recognized by putting the heel cord 
on stretch. In other words, the heel, cord is short 
when the foot can only be flexed upward to a right 
angle, with the knees straight. These are slight ab- 
normalties which can be easily corrected when brought 
to the attention of a physician. 

Old shoes, which have lost their shape and are run 
down at the heel, are particularly bad for the feet. 
They fail to give support and allow the body weight 
to fall excessively to one or the other side. Improper 
stockings are also a common evil. When of a hard 
unyielding texture or when too tight, they compress 
the toes and interfere with the circulation. A stock- 
ing too short is particularly pernicious, as this causes 
the toes to curl under. For ordinary purposes it is 



THE CARE OF CHILDREN'S FEET 193 

well to have the stockings half a size too large. Never 
mind the wrinkles; normal swelling of the active feet 
will smooth these out. 

A frequent change of both shoes and stockings is 
particularly beneficial to the feet. Teach the child to 
use the towel vigorously and to dry thoroughly the 
skin between the toes, as dampness here and excessive 
perspiration cause soft corns. 

Children who in early life have suffered from mal- 
nutrition and rickets are especially prone to weakness 
of the muscles of the feet. It is also not uncommon 
among children who have grown very rapidly, the 
muscular development not keeping pace with the body 
growth. Infectious diseases seem also to be a pre- 
disposing cause of weak and flabby muscles. These 
children need to be encouraged toward natural exer- 
cises which, in common with the development of other 
muscles, tend to strengthen the foot muscles. 

Running, jumping rope and all kinds of dancing, 
especially gymnasium dancing, bring the foot muscles 
into play and are especially adapted to their develop- 
ment. These children also need some exercises es- 
pecially adapted toward strengthening the muscles con- 
cerned with the maintenance of proper foot function. 
There are for this purpose some standardized exer- 
cises, most of which are modifications of those recom- 
mended by the United States Army Medical Depart- 
ment. 



194 THE CARE OF CHILDREN 

Exercise # i : With the feet exactly parallel and 
forming the two sides of a square, slowly raise 
one's self up on the toes, slowly returning to the 
heels. Also walk back and forth across the floor 
with the heel lifted, the weight of the body rest- 
ing on the toes and balls of the feet. 

This exercise brings into play the leg muscles and 
also strengthens the cross arch. 

Exercise #2 : Walk about the room with the feet 
turned on the outer borders, and while standing 
with the feet six inches apart raise the inner side 
of the foot and throw the weight on the outer 
side. 

This exercise stretches and brings into action the 
contracted muscles on the outer side of the foot and 
relieves the strain on the overstretched muscles and lig- 
aments supporting the inner arch. 

Exercise #3 : While seated with the leg supported 
on another chair with the foot over the edge of the 
chair, flex and extend the foot, that is, bend it up- 
wards and downwards as far as possible. Then 
while in this position, turn the foot so that the 
sole faces far inward. 

This stretches the anterior leg and foot muscles and 
exercises the muscles on the inner side of the foot. 

In practising these exercises commence with five 
minutes and then gradually increase to fifteen or twenty 
minutes. They should be repeated twice daily and 
should be carried on for at least two months. 

One of the very best exereises for strengthening the 



THE CARE OF CHILDREN'S FEET 195 

muscles supporting the long arch (the main arch of 
the foot) requires assistance in carrying it out : While 
sitting, hold the foot turned in as far as possible, while 
someone sitting opposite tries to resist the strength of 
the foot by turning it out. This is done by having the 
assistant grasp the heel in the palm of the left hand, 
and the top of the foot near the toes with the right 
hand, turning the foot out while the child tries to hold 
it turned in. 

In bad cases of "weak" or "flat" foot it may be nec- 
essary to have the inner border of the heels raised, 
and while the weak muscles are getting stronger, 
special shoes may be required. Such cases should al- 
ways for proper treatment be in the hands of an ortho- 
paedic surgeon. 



CHAPTER XXV 

MALNUTRITION AND THE CHILD 

Through physical examinations of large groups of 
children of school and pre-school age within the past 
few years it has been shown that virtually one child out 
of every three is undernourished. 

Preportionate to his size, the growing child requires 
more food than does an individual who has reached 
maturity. For, in addition to the food necessary to 
sustain life, the demands of growth must be supplied. 
This being true, if the intake of food is not sufficient 
we are -soon face to face with that monster, malnu- 
trition. These are the dangers of malnutrition: 

First. The child's resistance is lowered. This 
is of paramount importance, for in disease of any 
nature one's resistance may be the deciding factor 
between life and death. 

Second. The nervous system becomes unstable. 

Third. Mental development may be retarded. 

In other words, so far-reaching are its dangers that 
the child's entire life may be unfavorably influenced. 

It is not alone the children of the poor who suffer 
from malnutrition. They may be found in equal 

196 



MALNUTRITION AND THE CHILD 197 

numbers in homes of plenty in both city and country. 
And why is this? 

There are many factors that have a bearing on this 
broad question. Chief among them are: 

Faulty food habits; 
Physical causes; 
Mental disturbances. 

Incorrect food habits are legion. Chief among 
these are: 

Excessive milk drinking; 

Aversions to certain foods and allowing the child 

to select his own diet; 
Fast eating and improper chewing; 
Too much candy and sweets; 
Irregular eating and taking too much food at one 

time ; 
Inadequate breakfast and the tea and coffee habit. 

If kept on an exclusive milk diet after one year, or 
if after the eighteenth month milk is still the chief art- 
icle of diet, children will invariably be found poorly 
nourished; they are pale, cross and irritable; the ab- 
domen is usually prominent and the muscles are flabby. 
After the first year the diet should be gradually in- 
creased, since milk alone does not furnish the neces- 
sary materials for growth. If a child has the milk 
habit — that is, if all other food is refused, as some- 
times happens — milk should be entirely cut off until a 
taste for other food has been acquired. 

When a child begins to eat solid food, one of the 



198 THE CARE OF CHILDREN 

most important points in training is to teach him a 
taste for the things that are essential to his develop- 
ment; for it is in the early years that food habits are 
formed. Occasionally an idiosyncrasy to certain foods 
may be encountered; for example, some people are 
poisoned by strawberries, others by eggs; but as a 
rule most of the food aversions of childhood can be 
overcome by suggestion. Very often it is only neces- 
sary to tell a child that certain foods will help him 
to accomplish feats he has admired in others. A 
child should never be allowed to select his own diet, 
consequently eating too much of one thing and refus- 
ing others necessary for his health and growth. 

Eating too rapidly and without due regard to suffi- 
cient chewing leads to the development of a vicious 
circle, reacting on the body in different ways. There 
is indigestion and constipation. These lead to non- 
assimilation of the food eaten and loss of appetite, 
which can only result in malnutrition. 

The habit of fast eating is often formed by allow- 
ing the child to keep his mind on his play while eating. 
Eager to get back to this, he literally bolts his food. 
He "eats and runs"; and if allowed to do so he will 
frequently leave the table before taking anything like 
a normal amount of food. Eating and drinking at the 
same time helps to form the habit of insufficient chew- 
ing. 

Children should be allowed plenty of time for meals ; 
they should be taught to eat slowly and to chew their 



MALNUTRITION AND THE CHILD 199 

food thoroughly. Liquids should not be allowed 
while eating, unless the child's mouth is empty. Fast 
eating soon becomes a habit, and once formed it is 
hard to overcome. 

Candies and sweets, when eaten promiscuously, par- 
ticularly before meals, lend themselves toward mal- 
nutrition by destroying the appetite for other and more 
nutritious food. 

Irregular eating, or allowing a child to gorge him- 
self at one meal, upsets digestion and spoils the ap- 
petite for the next. Meals should be given at a defi- 
nite time each day, and from this rule there should 
be no deviation. 

In many homes children are allowed to rush off to 
school without eating an adequate breakfast. Often 
they indulge freely in tea or coffee, which leaves them 
no appetite for other food. It is among these children 
that some of the most extreme cases of malnutrition 
are found. 

It is during the early years that food habits are 
formed. Since a sufficient intake of food is the foun- 
dation of good health, the importance of painstaking 
care in this direction can not be overemphasized. 

Among the physical causes that are a factor in mal- 
nutrition are: 

Adenoids, enlarged and diseased tonsils, and bad 
teeth ; eye-strain ; lack of sufficient fresh air and exer- 
cise; excessive fatigue. 

Adenoids mechanically obstruct the respiration, 



200 THE CARE OF CHILDREN 

cause mouth-breathing, and are often the origin of in- 
flammatory processes in the nose and throat. Dis- 
eased tonsils and decayed teeth are not only culture- 
beds for all grades of acute or chronic infection, but 
they throw out poisons that impair the child's assim- 
ilation of food. 

Eye-strain is a factor, since it produces headache, 
nervousness and fatigue. These naturally affect the 
appetite. 

As a means of producing loss of appetite, close con- 
finement indoors, with lack of fresh air, has no equal. 
Every child who has reached the run-about age should 
spend at least five hours daily in the open air. Dur- 
ing very inclement weather in Winter the child should 
be given an indoor airing. For this, dress him as for 
the daily outing. Then open all the windows on one 
side of the room, closing all doors to prevent air cur- 
rents. 

An over-fatigued child is actually "too tired to eat." 
Since fatigue impairs digestion, the small appetite at 
this time is often nature's effort to prevent indigestion. 
If this extends over a long period, it means the expend- 
ing of more energy than is being created, and the re- 
sult is impaired nutrition. 

The overactive child should be induced to rest for 
a half-hour before lunch and before the evening meal. 
The rest should be taken in bed, with the clothing 
loosened and windows open. 

Unhappiness and worry have a bearing on malnu- 



MALNUTRITION AND THE CHILD 201 

trition, not alone in causing loss of appetite, but in 
interfering with the absorption and assimilation of 
food. Chief among the causes for mental depressions 
in childhood are: 

Too much discipline, too much school work, or 
worry over school standing. 

The next question is, when should a child be con- 
sidered malnourished ? 

There are various degrees of malnutrition, but gen- 
erally speaking any child habitually seven per cent, 
underweight is not well. To say he is sick would 
come nearer the truth. A child even five per cent, 
underweight needs extra care and watchfulness, for 
five per cent, underweight at seven years may mean 
ten per cent, or more at twelve years. 

Some of the physical and mental signs of malnutri- 
tion are : 

Paleness with lines under the eye, flabby muscles, 
prominent abdomen, stooping posture, round shoul- 
ders or projecting shoulder-blades, forget fulness, rest- 
lessness, inattentiveness, and irritability. The most 
infallible test is underweight for height. 

In addition to plenty of good, wholesome food, and 
the removal of physical or mental causes, malnourished 
children require fresh air and rest. They should 
sleep in well-ventilated rooms, go to bed regularly at 
an early hour (in order to secure at least ten hours' 
sleep), and have a rest period morning and evening. 
Their play should not be too hard or school work too 



202 THE CARE OF CHILDREN 

taxing. Since competition with well and strong chil- 
dren either in work or play means a drain on their 
reserve strength, it should be avoided as much as pos- 
sible; for, instead of drawing on their reserve, these 
children need to store up energy. 

We are giving below a table of "Average Heights 
and Weights." 



Average Heights and 


Weights 






BOYS 


girls 




Height 


Weight 


Height 


Weight 


Age 


In. 


\Lbs. 


In. 


Lbs. 


Birth 


20.6 


7-55 


20.5 


7.16 


3rd month 




1 175 




"•5 


6th month 


26y 2 


18 


25% 


16M 


7th month 


27Y4 


i9# 


26y 2 


17H 


8th month 


27 5 A 


19% 


27 


*m 


9th month 


2sy 8 


20^ 


27 5 A 


19H 


10th month 


2sy 2 


207/ S 


27 7 A 


19^ 


nth month 


29 


21A 


2sy 8 


20^ 


1 2th month 


29H 


21% 


2sy s 


20?4 


13th month 


297/s 


22% 


29 3 A 


21 


14th month 


30M 


23 


29^ 


2lA 


15 th month 


3°?4 


23 5 A 


z°A 


2I7A 


1 6th month 


3*H 


24Vs 


30^ 


22^ 


17th month 


3*H 


24 J A 


30K 


22% 


1 8th month 


31 3 A 


24H 


31^ 


23^ 


19th month 


32M 


25^ 


31^ 


23 3 A 



MALNUTRITION AND THE CHILD 203 

Average Heights and Weights 

boys GIRLS 

Height Weight Height Weight 

Age In. Lbs. In. *tt?7 

20th month 32^ 25 A 3 2 2 4A 

21st month 32^ 25% 32*4 24% 

22nd month 33% 267/s 3 2 H 2 SA 

23rd month 33^ 27 32% 25^ 

24th month 33J4 27^ 33^ 26^ 

25th month 34 27% 33 J4 26ji 

26th month 34^ 28% 33^ 27% 

27th month 34% 29 33% 27 K 

28th month 35^ 29^ 34^ 27 J4 

29th month SS 3 A 2 9 J A 34% 27% 

30th month 35 ^ 29^ 34% 28% 

31st month 35^ 30^ ssVs 28% 

32nd month 36 30^ 35 A 29 

33rd month 36^ 30^ 35^ 29^ 

34th month 36 ]/ 2 31 A 3 6 A 3° A 

35th month 36% 31% 36K 3°% 

36th month 37^ 32% 36% 30^ 

37th month 7>7 2 A 3 2 A 3&A 3°A 

38th month 37^ 32^ 37 31 

39th month 37^ 335^ 37 A &H 

40th month 38^ 33^ 37^ 32 

41st month 38^ 33^ 37 H. 3 2 A 

42nd month 38^ 33% 3 8 3 2 /^ 

43rd month 38% zzA 38% 32% 



204 THE CARE OF CHILDREN 



44th month 


38% 


34K 


38/2 


33 


45th month 


39 


34^ 


&/* 


33% 


46th month 


39 


34M 


38% 


33^ 


47th month 


39M 


35M 


38ji 


33^ 


48th month 


39^ 


zsH 


39 


33 3 A 



Note. — The figures for height and weight at birth and weight 
at three months are from Charles Gilmore Kerley (Short Talks 
With Young Mothers, pages nine and eleven). 

The figures for height and weight from 6 to 48 months are 
from the Anthropometric Table compiled for The American 
Medical Association by F. S. Crum and are based on the 
measurements of 10,423 normal babies (5,602 boys and 4,821 
girls) examined at Baby Health Conferences in 31 states and 
possibly represent measurements slightly above the average, 
especially in weight. 

In comparing these figures with average figures for height 
and weight for the 6th, 12th, 18th and 24th month, (Charles Gil- 
more Kerley, Short Talks With Young Mothers, pages nine and 
eleven,) we find a variation of from one to two pounds in 
the weights and from one half to one and a half inches in the 
heights. 

The Average Heights and Weights for Children under two 
years of age, are also higher than those given by the Child 
Welfare Hygiene Section, Canadian Public Health Association. 
A variation of from one to two pounds in the weights and from 
one half to one and a half inches in the heights, from the 
averages given in the table above, should therefore not be con- 
sidered abnormal for children under two years of age. 



CHAPTER XXVI 

THE CHILD'S EYES 

Somewhere I have seen a picture representing an 
old man asleep in his chair, while before him stood 
all the implements of his work. Death hovering near 
touched him on the shoulder. And in his hand Death 
carried a child ready to take on the old man's work. 

The children are the hope of the future. It is the 
children of today who will make the community of 
tomorrow. And in order that they may be prepared, 
as soon as they must, to take our places, it is of great 
importance that children should grow up without 
handicaps. 

To a great extent success and safety in life depend 
upon good eyesight. And in these days, when the 
demands of civilization have increased the perilous 
conditions under which the eyes are used, their hy- 
giene is particularly important. Not only is there 
much defect of vision undoubtedly due to preventable 
causes but the great number of young people suffering 
from eye strain proves there is still need for popular 
education on the ordinary care of the eyes. 

New-born infants are very sensitive to bright lights 

either natural or artificial. They should not be sub- 

205 



206 THE CARE OF CHILDREN 

jected to a strong light for two or three weeks. A 
young child should never be allowed to face the sun, 
as this will cause the habit of squinting and may be 
productive of serious defects of vision. Nurse-maids 
who take young children out into the open should be 
thoroughly instructed on this subject. 

In the bedroom and nursery neutral and dark tints 
should be used, but never white. If a white parasol 
is used over a carriage, it should be lined with a color, 
preferably green. 

During such infectious diseases as scarlet fever, 
whooping-cough, and particularly measles, the eyes 
should be carefully protected. For the first few days 
have the room moderately dark, as at this time the 
eyes are abnormally sensitive to light. Hot com- 
presses of boric-acid solution (see page 37, "Mater- 
nal Nursing") will relieve pain. During the convales- 
cent period, avoid strain by use and keep the child on 
a low diet. 

A young child should not be allowed to look at 
anything requiring, for a considerable period, close vi- 
sion, since the so-called fusion of the vision develops 
very slowly. In fact systematic work is safe only 
after the occular tissues have passed the formative 
stage of development. And why is this? 

Because, normally, a young child is farsighted and 
although the accommodation is- active enough, it is not 
so easily employed as to enable the child to obtain 
clear images for very long. In other words, fatigue 



THE CHILD'S EYES 207 

of the eye muscle soon takes place. And if unduly 
stimulated the muscular strain tends to distort the eye- 
ball causing pressure upon the cornea. 

The formative stage of development is not fully 
acquired until the child is eight or ten years old. And 
if before this time the eyes are used for close applica- 
tion it is apt to cause some impairment of vision. 

One of the most fruitful evil results of eye strain 
in childhood is nearsightedness. This usually begins 
in childhood and goes on increasing according to the 
strain. Statistics show that only one or two per cent, 
of children are nearsighted at birth. The great prev- 
alence of this defect is largely due to the demands of 
civilization. Among savage races nearsightedness is 
unknown, because from childhood these people use the 
eyes passively, that is, they focus mostly upon distant 
objects. In other words, looking upon distant objects 
requires no muscular effort. But in accommodating 
the eye to near objects the adjustment is brought about 
by muscular efforts, and is more or less fatiguing even 
to adults. 

When school age is reached, care should be exercised 
to see that a child just beginning to study does not 
abuse his eyes. Some of the earliest principles to 
teach a child just beginning to use books are: 

First. Never to sit facing the light but let the 
light come behind or over the left shoulder. 

Second. To avoid books or paper printed in- 
distinctly or in small type. 



208 THE CARE OF CHILDREN 

Third. Never to read in the twilight; in a reclin- 
ing position or with the sun shining directly on the 
book. 

Fourth. When reading, to hold the book from 
twelve to fourteen inches from the face and to hold 
the head up. 

The habit of holding the book too close to the eyes 
is easily formed. This will cause a strain of the 
muscles both within and on the outside of the eye-ball 
and is a cause for nearsightedness. 

In any close application of the eyes, teach the child 
the necessity for frequently resting them by looking 
away from the material or book and letting the eyes 
rest on distant objects. There is nothing so restful 
to the eye as the foreground of Nature. It is not 
only painted in colors least apt to tire the eyes but 
in viewing it there is an unconscious relaxation of the 
eye muscles. For this reason alone (and there are 
many others) the child attending school should never 
after school hours be deprived of his hours of play in 
the open. 

Many children are greatly retarded in their school 
work by some defect of vision. To such an extent 
does this often incapacitate, they become discouraged. 
Such children are usually considered stupid and lazy, 
while the real trouble is that since they cannot acquire 
an education easily and naturally, they give up the 
struggle. 

In an effort to see more distinctly, children some- 



THE CHILD'S EYES 209 

times bend the body forward or tilt the head at various 
angles. They should without delay be taken to a good 
oculist. For many spinal curvatures are thought to 
be of ocular origin. And how may these be brought 
about ? 

The child in studying or writing continually assumes 
an abnormal position. That is, the head and body is 
turned to one side. This is brought about either 
through an axis of astigmatism, that compels head 
tilting, or because of dominance of one eye. 

There are many children who need glasses at an 
early age. Even normal vision does not preclude eye 
strain. A medical writer on this subject has said: 
"Eye strain is the more easily overlooked because it 
often accompanies perfect vision and paradoxical as 
it may seem is more likely to follow small errors than 
large ones. The one who has a very large error 
strains for clear vision, but after a time ceases be- 
cause it is of no avail and is contented with limited 
vision, while the one with small error often continues 
straining because it enables him to see distinctly." 
And what is the real significance of this? 

Simply that the child with fairly normal eyes — 
using them to excess — is often the one who suffers 
from subsequent eye diseases, rather than the child 
with especially defective eyesight. 

It is by no means unusual for eye strain to cause 
reflex disturbances in distant parts of the body, the 
general health thereby being much disturbed. During 



210 THE CARE OF CHILDREN 

the early school age, should there be unusual restless- 
ness, headaches, irritability or gastro-intestinal dis- 
turbances, the eyes as a possible cause should not be 
overlooked. And wherever a child is found to have 
constant headaches during and after school work, that 
child is by its efforts at study surely harming the eyes. 

The farsighted child suffers from headaches in his 
efforts to see near objects. In fact such a child can 
bear close work less easily than the one with the de- 
fective vision which accompanies nearsightedness. 
And unless relieved by glasses not only will the child's 
health become impaired but he is very apt to become 
careless and shiftless in school work. 

While the nearsighted child does not usually suffer 
from headaches, he will be unable to see black-boards 
or other distant objects used in teaching. And there 
is a tendency, unless something is done to protect them, 
for nearsighted eyes to become worse, so without 
proper care seriously impaired vision may be the re- 
sult. 

Numerous school statistics have proven in a marked 
degree, not only that the percentage increases from 
year to year, but the nearsightedness becomes pro- 
gressively greater, as the child advances from the 
lower to the upper grades. 

There is a common belief that squint eye so preval- 
ent among young children, is caused by the infectious 
diseases, such as scarlet fever or measles. This 
idea is erroneous. Squint eye is usually caused by 



THE CHILD'S EYES 211 

farsightedness, often combined with astigmatism. 
The squint develops usually between the ages of one 
and five. It is brought about in most cases through 
use of the eyes without glasses, which correct the far- 
sightedness, for close observation. 

If a cross-eye should appear in a young child, he 
should be put into the hands of a competent physician, 
who will at once refract it. This should not be neg- 
lected, as it is a question of preserving the sight in 
an eye that otherwise may become practically useless. 

Even if there is no evidence of eye trouble, when a 
child becomes of school age, it is well to have his 
eyes examined. This is a precautionary measure of 
great value, as it discovers the degree of the child's 
vision and disease or errors that might exist. 

Pink eye is a common infection among school chil- 
dren. It is marked by redness of the eyes, a muco- 
purulent discharge and a feeling as if grains of sand 
were sticking under the lid. This is highly contagious. 
The child should be kept from school and as long as 
there is any inflammation present, should not use the 
eyes. Any article coming in contact with the child's 
eyes should be strictly isolated to prevent spreading 
the infection to other members of the family. Pink 
eye usually lasts from ten days to two weeks and 
terminates favorably. In its initial stage apply cold 
compresses and call in a physician. 



CHAPTER XXVII 

OPHTHALMIA NEONATORUM 

I went to a hospital today to distribute some pres- 
ents to little children — presents selected by one who 
knew personally every little child and knowing had 
selected what she thought would bring to each the 
most happiness. Before I had finished distributing the 
packages, a little hand tugged at my arm and I heard : 
"Read it! Read it!" I turned to find Roger. He 
held before me a book, repeating again : "Read it to 
me!" I stopped, hesitated and wondered, for I re- 
membered that the little present which I had handed 
Roger was a ball and a small tennis racket and not this 
book such as had been given the other boys of his age. 
I knew also that the ball and racket carried with it 
not only more real thought than anything else but real 
heart throbs, for Miss Harris loved Roger better than 
any of the other children. 

I was awakened from this little reverie by the touch 
of a little arm clasp around my waist and the words— - : 
"My eyes are bad, read it to me," as he held the bodk 
before me. 

Those words, "my eyes are bad," told a sad story. 
Roger was nine years old. He had never been to 

212 



OPHTHALMIA NEONATORUM 213 

school. While not entirely blind he would never know 
the joy of anything like normal eyesight, fo*r tiny 
scars partly covered those beautiful brown eyes. No 
one ever noticed those scars and Roger did not know of 
their presence, but they kept him from seeing well 
enough to study and he could not compete with the 
other children and now had come that insatiable thirst 
for knowledge of the bright, active child. And with 
this sad realization, perhaps for the first time, that he 
was different, quite different from the other children. 
What was it that had caused those scars over Rogers 
eyes? 

When a tiny baby he had that form of inflammation 
of the eyes called "Ophthalmia Neonatorum." This 
is an inflammation responsible for about ten per cent, 
of the blind in the United States and for about ten 
to twelve per cent, of all the inmates of blind asylums. 
It is caused by germs getting into the eyes during or 
after birth. These germs cause redness, swelling, and 
a discharge. If these symptoms are allowed to go on 
without treatment, an ulcer is likely to form and a scar 
is the result. It is these scars which obstruct the 
vision. 

So here was little Roger paying the price because 
the mother who loved him so dearly, did not know 
what might follow neglect of a baby's eyes. But she 
knows now — now that it is too late. One day when 
I met her at the hospital, I asked a few questions. It 
was the same sad story I had heard so often before. 



214 THE CARE OF CHILDREN 

He was born with perfect eyes, she was sure. 
"Oh, yes!" she said "beautiful brown eyes!" But 
soon the lids became red and swollen and there was a 
discharge from beneath them. She thought it was 
simply cold in the eyes and would get well of its own 
accord. 

Today our hearts are filled with sympathy for men 
blinded in battle. What about the large number — 
more than three hundred thousand — who have not 
that great compensation of having sacrificed their sight 
for a glorious cause? What about the little children 
hopelessly handicapped because they were unable to 
defend themselves and either through ignorance or 
carelessness, those who were responsible neglected to 
safeguard their most precious birthright — their eye- 
sight. 

The care of a baby's eyes should begin even before 
they have seen the light of day. Immediately after the 
head is born and before the delivery of the body, the 
eyes should be carefully wiped free from mucus or 
blood with a small piece of clean absorbent cotton or 
soft old household linen sterilized by boiling and 
dipped in boiled water or a solution of boric acid, just 
before using. Use a separate piece for each eye and 
discard as soon as it has been used once. The stroke 
should be from the nose outward and made with the 
greatest gentleness, without opening the lid. As soon 
as possible after the birth of the body the eyelids 
should again be wiped free from mucus, the eyelids 



OPHTHALMIA NEONATORUM 215 

gently opened and two drops of a one per cent, solu- 
tion of Silver Nitrate dropped into each eye. The 
Silver Nitrate treatment of the eyes of the newborn, 
called Crede treatment (first used by a doctor of that 
name) if universally used would almost eliminate 
Ophthalmia Neonatorum and its dreadful consequences. 
This solution should be furnished by the doctor and 
should be put into the baby's eyes by the doctor or 
nurse — never by the mother or a friend. This pre- 
cautionary measure is necessary because the baby's 
eyes may have become infected during the passage of 
the head through the birth canal. Of such immense 
value is this preventive measure considered in safe- 
guarding eyesight, many states have enacted a law 
compelling physicians and all who minister to women 
in child-birth to use it. Mothers should by all means 
insist upon its use. 

Should your baby's eyes become red and swollen and 
there is any sign of a yellow discharge, lose no time 
in placing him in the hands of a competent physician. 
Your baby's eyesight may be saved by a few hours 
care of this kind while neglect may cause life-long 
blindness or at least seriously impaired vision. 

There is an unfortunate belief that all sore eyes are 
caused by the germ of the social disease called "Gon- 
orrhea." While gonococcus does cause numerous eye 
infections, the eyes are also made sore by numerous 
other germs and diseases of innocent origin. The 
sore eyes of your child are not a disgrace but blind- 



216 THE CARE OF CHILDREN 

ness or seriously impaired vision is — for it shows 
utter neglect. 

In any case of eye inflammation, the greatest care 
must be taken not to infect one eye from the other. 
Always use different pieces of cotton or gauze for 
each eye and never pass the same swab twice over 
the eye, take a new piece each time. 

Be very sure that anything used for the baby does 
not come in contact with anyone else, since most eye 
inflammations are highly infectious and other members 
of the household may become infected. All swabs or 
sponges should be placed on paper after using and 
burned at once. And as infection may also be carried 
by the fingers, the hand after coming in contact with 
the eyes should be scrubbed with a brush under run- 
ning water, especially should this be done if the eye 
contains pus. 

In bathing the face of a baby use a clean piece of 
linen and fresh water; never use the same cloth with 
which the rest of the body has been cleansed. Care 
should be exercised not to allow any soapy water to 
enter the baby's eyes in bathing. Carelessness along 
these lines often causes severe inflammation of the eyes. 
Each time the baby is given a bath, the eyes should 
be gently swabbed out (starting from the nose out- 
ward) by dipping a clean piece of gauze in a satu- 
rated solution of boric acid, alwiays using a separate 
piece for each eye. 



CHAPTER XXVIII 

FEARS OF CHILDHOOD 

Allen was four years old, so for a long, long 
time it had been his custom after being "tucked in" 
by mother to sleep quietly throughout the night. So 
when one night he appeared in the family circle, 
arrayed in his night clothes and complaining of a 
pain in his foot there was no reason to doubt the 
sincerity of his statement. After applying some sim- 
ple measure his mother went with him to his bedroom 
and sat by his bed until he went to sleep, which he 
did promptly. But when this same thing happened 
the next night and the next, Allen's mother began to 
wonder what it meant, especially as the pain was not 
always in the same place and he never complained of 
it during the day no matter how hard he played. So 
after this had happened a number of times, his mother, 
when tucking him in one night, said: "If you have 
the pain tonight you are not to leave your bed, rub 
it yourself just as mother does." Hardly an hour 
passed before Allen was heard crying in bed. When 
his mother went to him to inquire the cause, she was 
a little surprised to hear him say: 

"Stay here with me, there are lions in the house, 

217 



218 THE CARE OF CHILDREN 

they will eat me." Then it was she understood why 
he had feigned the pain. He had been much im- 
pressed with the roaring of the lions at the menagerie 
which he had been visiting daily and although it had 
not seemed to terrify him at the time, here was a be- 
ginning fear. 

"And what did you do?" I asked as Allen's mother 
told me this little story. 

"I at first embraced him, thus giving him a feeling 
of security, and then we talked of something else. 
When he was ready for it, or in other words after the 
feeling of protection had been established, we talked 
of the big lions and how they could never get out, 
therefore, there were none in the house and so there 
was nothing to fear." "In the end," she went on to 
say, "we laughed about the roaring of the lions. 
Then, he turned over to go to sleep and to think, 
as I suggested, of his little bunnies in their bed fast 
asleep." 

This was all a very simple substitution, but this 
mother was applying mental prophylaxis and had 
nipped in the bud the formation of a fear, which if 
injudiciously handled might have become a serious 
fear psychosis. 

It is not every mother who recognizes the symptoms 
of a growing fear (for it is not always an easy task) 
and very few realize the danger of allowing a fear or 
any other trait to become deeply rooted or abnormally 
developed in childhood. The fact that real dangers 



FEARS OF CHILDHOOD 219 

along this line do exist has long been known. In fact, 
doctors all over the world are continually finding 
people who are unable to live their lives normally be- 
cause of some psychopathic disorder. And what do 
we mean by this ? 

We mean that there are men and women suffering 
from weird obsessions, abnormal dreads, haunting 
fears, annoying thoughts, morbid anxieties and even 
disturbing bodily symptoms, not from any physical 
cause at all, but because of some error in mental 
hygiene during childhood; we mean that the seeds of 
many nervous disorders in adult life are sown in child- 
hood. 

Now, let us see how a fear psychosis is developed. 
First, we know that self-preservation is the first law 
of life, therefore, the fear instinct is in itself a normal 
one, being, as it is, deeply rooted in the impulse of 
self-preservation. This instinct is generally made 
subservient to the will by environment and education. 
But there are certain children who inherit an unstable 
nervous system ; they are impressionable and over sug- 
gestible. It is these children who under certain con- 
ditions of training and environment have the fear in- 
stinct over-developed. It is then that fertile soil is 
formed wherein may grow various psychopathic 
troubles. Exciting the imagination of the young 
child in an unhealthy way, by ghost stories, harrowing 
fairy tales, or by frightening him, is one of the most 
potent factors in the excessive development of the fear 



220 THE CARE OF CHILDREN 

instinct. "Every ugly thing told to the child, every 
shock, every fright,' ' says Angelo Mosso, "will remain 
like minute splinters in the flesh to torture him all his 
life long." 

How do these thing react on the child in an un- 
healthy way? 

First, we must remember that a child's brain is ex- 
cessively impressionable and very active, in fact the 
brain never works more actively than during child- 
hood, which fact is shown in one way by a child's 
quick acquisition of language. Next, the imagination 
of a child is far more vivid than an adult's and his 
life is more or less made up of emotions. Lastly, his 
very helplessness makes him very fearful. Now some- 
thing is told to him that frightens or greatly disturbs 
him. Does the child forget it in a short time? 

Apparently he does. He may never speak of it 
again and if asked about it might not recall it. Yet, 
the incident or the shock from it has not been for- 
gotten. It has been registered in the child's sub- 
conscious mind and may give evidence of its continual 
existence by some seemingly inexplicable fear or 
phobia later in life. 

"The ineradicability of fear when inculcated early in 
childhood/' says Dr. Tom Williams, "is illustrated by 
the case of a Southern lady, who even at an advanced 
age dared not go alone into the dark, because of the 
feeling of indescribable horror which it gave her, 
although she had long since ceased to believe in the 



FEARS OF CHILDHOOD 221 

stones (told her by Southern darkies) which orig- 
inally made her afraid to do so. She realized this 
so forcibly, herself that she would not allow any of 
her children to be told alarming tales. This psycho- 
prophylaxis resulted in her girls' never knowing what 
it meant to be afraid in the dark." 

Another case was that of a young girl who at the 
age of sixteen had never been regularly to school on 
account of great nervousness. This girl could not be 
induced to go upstairs alone at night and was afraid 
to sleep alone. She dreamed a great deal and always 
awakened frightened, clutching her companion desper- 
ately for reassurance. Noises such as creaking floors 
made her think there was some one in the house, and 
although she knew there was not, she could not make 
herself believe it. Her fears were always of fires or 
burglars and they occurred only when she was in bed 
or asleep. Analysis and inquiries showed that a 
servant had told her and two older sisters terrifying 
stories, when children, but these horrors had passed 
away from the other two children. 

Sometimes a fright in childhood is the starting point 
for an unusually peculiar phobia. I remember well 
a grown woman who had an abnormal dread of seeing 
or touching anything with feathers; she even feared 
a feather on a hat to touch her. This was found to 
have been caused by a swallow flying into her face. 
When a small child, she entered one summer evening 
a dark room in which there was an open fireplace. 



222 THE CARE OF CHILDREN 

A swallow having entered the room by way of the 
chimney was flying around in an effort to escape and 
thus the bird flew into her face. This frightened the 
child badly. She apparently soon forgot about it, but 
the shock remained in her sub-conscious memory. 

These and various other phobias and mental con- 
flicts with which children, men and women struggle, 
are usually characterized by those coming in contact 
with such a sufferer, just as a "peculiar kink" in one's 
make-up. That they suffer keenly and are seriously 
handicapped for any career is seldom appreciated. 

Once these fears and phobias have been formed they 
can only be dispersed by the resources of a good 
neurologist, that is, they are entirely curable by mod- 
ern psychotherapy. And how are these cures made? 

First, they try to find out what was the foundation 
or beginning of the obsession — the root of the evil. 
But how? 

By several methods. Sometimes by dream analysis. 
Sometimes by hypnotizing the subject. Having ar- 
rived at the cause, they proceed to help the subject to 
a realization of the situation. Sometimes they teach 
him to interpret the symptoms of a disorder produced 
by the emotions ; they give him training in concentra- 
tion and self-control ; they give him a change of mental 
attitude and gradually suggest away the hidden mem- 
ory image. 

The teachings of modern psychology make it clear 
that two principles must be kept in mind by those 



FEARS OF CHILDHOOD 223 

who have charge of young children. One is the avoid- 
ance of suggestions that stimulate fears. The other, 
to make it a point to develop in a child the virtues 
of courage and self control. And how are these vir- 
tures developed? 

As the chief source of all fear is ignorance and lack 
of understanding, it naturally follows that when a 
child is afraid of something, it must be explained to 
him and the fear suggested away. Take, for instance, 
the fear of a dark room. It will not make the child 
less afraid by telling him: "There is nothing to be 
afraid of." And if in connection with this he is either 
scolded or laughed at, matters are made worse. You 
have added another fear to the one he already has — 
the fear of being ridiculed. Thus the child tries to 
conceal his feelings and to hide his fears within him- 
self. Often this is done to the detriment of his mental 
and physical health. 

On the other hand, suppose we explain the dark- 
ness, perhaps make a light in the room, afterwards 
making it dark again. Then, when we feel that he is 
prepared for it, we take him gently by the hand and 
lead him into the room, or perhaps only to the door. 
What is the result? 

The child has had a chance to demonstrate to him- 
self that there is nothing of which to be afraid. He 
is then, of course, no longer afraid. 

A little girl I knew was fearfully afraid of dogs. 
At the first sight of one she would run and scream. 



224 THE CARE OF CHILDREN 

As she grew older this fear did not subside. So one 
day while in the home of a playmate, who had a large, 
unusually lovable dog, her mother sought to demon- 
strate that the dog would not hurt her. First, she 
petted the dog and while stroking his extended paw, 
called to the little girl, saying: "I believe he is a 
Prince inside just like the Beast in Beauty and the 
Beast. You know you were talking about him only a 
short time ago." Finally, she persuaded her to come 
forward and stroke his paw. This the child did with 
some reluctance at first and while standing as far 
away as her little arm could reach. But she grad- 
ually grew to love the dog and her fears in this direc- 
tion disappeared. 

Self control is easily taught in infancy and child- 
hood, but to be learned after the age of puberty, re- 
quires powerful motives and determination. If par- 
ents would pay more attention to the development of 
this quality in childhood and would aid children as 
far as possible to go on their way undeterred by fears, 
frights or ugly thoughts, little would be heard of the 
functional nervous and mental disorders, now so prev- 
alent. 



CHAPTER XXIX 

FACTORS INFLUENCING THE NERVOUS 
HEALTH OF CHILDREN 

More and more is there a growing consciousness 
among those who have to do with adult maladjust- 
ments that these as well as many of the nervous mal- 
adies and much physical inferiority are largely due to 
the mistakes of childhood — to faulty habits, mental 
and otherwise, acquired usually in early life, as a re- 
sult of wrongful education, a poor environment or 
example. 

The constitution which one inherits and the influ- 
ences to which the body, especially the nervous system, 
are exposed during life and particularly during child- 
hood, are the two great factors which determine 
whether or not one will become nervous. While 
heredity is an unquestionable factor, environment is 
probably more responsible for the neurotic tendencies 
in childhood. And without doubt much so often at- 
tributed to inheritance is the result of the influences 
of enviroment. There is, in fact, one period during 
life in which heredity and environment may be said 
to overlap. This period is during early childhood. 

The most important feature of a child's environ- 

225 



226 THE CARE OF CHILDREN 

ment is his training and education. And the period 
most often neglected is that which comes prior to the 
school age. For the so-called fixed habits are the 
ones stamped early upon the child. They are formed 
during the physical and mental development in the 
first years of life. "Give me the first seven years of a 
child's life and I care not who has the rest" is a say- 
ing attributed to the Jesuits. 

Nervousness is a characteristic malady of childhood. 
Its first treatment is preventive. And now what are 
some of the factors that may influence the nervous 
health of children? 

First, we may mention imperfect nutrition in early 
childhood. This may lead to so great an impover- 
ishment of the tissues and to such checking of the 
natural development that in later life one may never 
be able to stem the torrent of its ill effects. While 
it is, of course, important that a diet of the right 
chemical composition should be given, it is equally 
necessary to develop in the child good habits of adapt- 
ing itself to a well regulated regime. And what do we 
mean by good habits of adaptation? 

We mean that no opportunity should be given the 
child of imposing its will — to get "notions" or to 
"fuss" over details. So frequently the mistake is 
made of allowing the child's fancy to influence the 
diet. Good, simple foods in suitable amounts should 
be provided, and the child, largely independent of 
choice, trained to eat them. Bad eating habits cause 



NERVOUS HEALTH OF CHILDREN 227 

irritability, anaemia and malnutrition. They lead in 
later life to many breakdowns. Childhood is the 
time to overcome tendencies in this direction. For if 
correction is neglected until after the age of puberty, 
there is small hope of improvement. It has long ago 
been remarked by medical men, familiar with the evils 
both mental and physical, directly traceable to this — 
one of life's worst pit-falls — that the child who is not 
allowed to cultivate food aversions but who learns to 
eat and digest all wholesome foods, makes the very 
best start in life. For all too often the little food 
antipathies of childhood, if fostered, develop into a 
scrupulous apprehension concerning the effects of vari- 
ous foods. This, so often in adult life, leads to some 
morbid anxiety regarding the health. 

As correct habits with regard to food are aiding in 
the development of sound personality, the same prin- 
ciple applies to other bodily functions. Thus proper 
hours of sleep, fresh air, bathing and exercise, all have, 
as prophylactic measures against nervousness, an im- 
portant place. 

Faulty habits in regard to sleep, are perhaps as fre- 
quent as those pertaining to food. Many children, 
owing to faulty training, do not get sufficient sleep. 
They so dominate that unless the parent goes to bed 
at an early hour they will refuse to sleep. To such 
an extent do these children contrive to assert their own 
will, the parent is taught to accede to their demands. 
Many a pale and nervous child owes this condition 



228 THE CARE OF CHILDREN 

entirely to lack of sufficient sleep, due to the fact that 
the mother, unable to resist the appeal of the moment, 
has not insisted upon a healthy regime and sound 
sleep habits have not been established. It should be 
remembered that habit is an important factor in sleep. 
From the beginning, the child should become accus- 
tomed to being put down while awake and should go 
to sleep of his own accord. The habit of regularity 
should be formed not only as to a regular bedtime 
hour but also in the taking of "naps." The older 
children grow, the less they like going early to bed 
and "bickering" about bedtime is sometimes allowed 
to become a family habit, all too often the child learn- 
ing that Mother does not mean what she says. The 
habit of going to bed at regular times formed during 
the first years of life can be made to hold as long as 
the mother insists it shall be done. Up to seven 
years of age, the rule to bed at six should be enforced, 
and the bad habit of sitting by the child while he goes 
to sleep should never be begun. 

The importance of harmonious muscular develop- 
ment as promoted by out-door exercise, for the welfare 
of the nervous system of the growing child, has been 
recognized by both physicians and laymen, since the 
old Greek times. Correct postural attitudes, good 
respiratory and articulatory habits, also have a con- 
spicuous place in educational methods against nervous- 
ness. This is true not only because of their esthetic 
value but because they tend also to give other qualities, 



NERVOUS HEALTH OF CHILDREN 229 

namely — greater self-respect, self-control and self-re- 
liance. 

Children should very early learn the lesson of self- 
control. If by crying or by a display of temper, the 
child learns that the desired thing is to be obtained, 
he will have made a very bad start. "How often has 
an indulgent mother given a child something it has 
asked for in order to stop its crying and to avoid a 
scene!" writes Doctor Lewellys Barker, adding: "It 
is hard to imagine anything, in the circumstances, 
worse for the child. If, instead, the mother had 
ignored the temper and told the child that it must say 
'please' and must wait a few moments after its temper 
had been controlled and the request has been made 
before the desire will be gratified, it would have been 
quickly possible to convince the child that it can get 
things by controlling itself rather than by emotional 
explosions. The substitution of self-mastery for emo- 
tional outbreaks is easy when begun early but very 
difficult, indeed, well nigh impossible, if begun late in 
life." Very often emotional outbreaks in young chil- 
dren are considered just naughty habits which will be 
outgrown. But will they? No! One does not just 
grow into self-control. Neither can it be taught by 
reproof or reprimand. It must be practised in acts. 
It is just these naughty habits continuing in one form 
or another, which in adult life so often take the form 
of "nerves." 

An important cause for nervousness is the tendency 



2 3 o THE CARE OF CHILDREN 

of some mothers to over-protection and over-anxiety. 
They are constantly shielding the child from the 
rough places of life and there is an undue solicitude 
as to his welfare, the slightest symptom causing the 
greatest alarm. The child is thus endowed with an 
abnormally sensitive and impressionable nervous sys- 
tem. Later on, when in the nature of things the 
principle of protection must yield to the principle of 
effort, the sensitive nervous system suffers keenly. 

Some children are particularly impressionable and 
over-suggestible, and under certain conditions of train- 
ing and environment the fear instinct is over-devel- 
oped. This is, in fact, one of the earliest influences 
which later contributes its share to a neurasthenic pre- 
disposition. The teachings of modern psychology 
particularly direct attention to two principles which 
should be borne in mind by those who have charge of 
young children. One is the avoidance of suggestions 
that stimulate fears. The other to make it a point 
to develop the virtues of courage and self-reliance. 

The craving of the child for sympathy and dawd- 
ling are mental attitudes that bear watching. To yield 
too much to the craving for sympathy is most unkind. 
This is sometimes induced by excessive petting when 
tired or after an injury. When tired the child should 
be put to bed and after an injury his attention should 
be diverted. On the other hand, the denial of sym- 
pathy to the extent of suppressing his natural sym- 
pathy is equally bad. While an undue or unhealthy 



NERVOUS HEALTH OF CHILDREN 231 

sympathy should be avoided, the natural peculiarities of 
the child should not be forgotten. 

The dawdling tendency is often shown by idling 
unduly over meals. The child should be taught to eat 
his meals within a reasonable length of time. If he 
persists in lingering, take the food away and let 
him go without. If not hungry he will be all the 
better for going without, and if he is, the added 
hunger will prevent repetition of the fault which is 
one of the first steps toward the formation of a bad 
habit. 

A tendency to sulkiness, or cherishing ill-will, 
should be viewed as symptoms seriously to be studied 
and combatted. For if not curbed, habits may be 
formed which will prepare fertile soil for the later 
development of mental states very harmful to the nerv- 
ous system. So admirably has Doctor William H. 
Burnham covered this in one of the seven conditions of 
healthful mental activity in "Mental Health for Nor- 
mal Children" we cannot do better than quote a few 
significant sentences: "Children should be taught to 
live one day at a time, to settle their moral accounts 
every night, never to hold a grudge, never to let the 
sun go down upon their wrath, to look upon each 
morning as a new day in which to improve, but not to 
carry over their troubles from yesterday. It should 
be remembered that cheerfulness and kindliness are 
contagious and, unfortunately, so are moroseness and 
ill-will. If those who surround the child tend to con- 



232 THE CARE OF CHILDREN 

tinually disparage and censure those about whom they 
talk, they may often quite unconsciously sow the seeds 
of enmity and ill-will in young minds." 

The child inclined to be diffident and unsocial, who 
reads too much or who plays with others too little, and 
who makes few friends, may develop what is called 
a "shut-in" personality. These children are apt to be- 
come suspicious or to have ideas of inferiority or su- 
periority. It is better for a child's mental health to 
eat, play, work and study with other children^ than 
alone or even exclusively with adults. Free play either 
as follower or leader is a powerful antidote in over- 
coming the "shut-in" type of personality. In other 
words, children should be encouraged to be social ani- 
mals. 

As a factor making for health of the nervous sys- 
tem, the joy of work should not be overlooked. It is 
the instinctive tendency of the child to accomplish 
something. This is shown by the fact that he will 
quickly imitate acts of his elders. The satisfaction 
of having performed constructive work in a success- 
ful manner is not confined to mature men and women, 
but may come very early in the lives of children. 

The difference between play and work should be 
clearly understood by the child and the greater dignity 
of the latter impressed upon his mind at an early age. 
Education and occupation are the best kind of build- 
ers of a healthy nervous system. 



NERVOUS HEALTH OF CHILDREN 233 

Some of the physical causes for nervousness in chil- 
dren are : 

Adenoids, decayed teeth, indigestion and anaemia, 
which provoke inadequate action of the nervous sys- 
tem. 

The country offers the most favorable condition for 
the health and education of a child predisposed to 
nervousness. It is there amid "the glory of raw 
materials" that the human plant thrives best. For as 
Browning expresses it: — 

"It was better youth 

Should strive, through acts uncouth, 

Toward making, than repose on aught found made." 



CHAPTER XXX 

THE ACTIVITY OF A CHILD AND WHY IT 
SHOULD NOT BE REPRESSED 

' f Children should be seen and not heard" was a 
frequently quoted maxim of our grandmothers. 

In the progress and growth of a little child nothing 
is more remarkable than his activity. Unfortunately, 
thoughtless and cruel efforts are often made to repress 
it. 

A child has a gradual awakening to the discovery of 
himself and his surroundings. His first aimless Teach- 
ings for things are earnest efforts. After he has 
learned to walk, he enters upon a constant and vig- 
orous course of activity interrupted only by periods of 
sleep. This desire for activity is no less fundamental 
than his desire for food. It should not be needlessly 
repressed. Forbidden or dangerous articles should 
not be left within reach, to be snatched away just as he 
is beginning to imitate their use, as he has observed 
it in older people. The important point is to give the 
child a sense of freedom while guarding his safety. 

The strongest of all the promptings of Nature is 
the impulse of the child to play. And this ardent 
desire for play and amusement is implanted for a 

234 



THE ACTIVITY OF A CHILD 235 

purpose, it serves an end. Now why is this such a 
universal and deep-seated propensity? 

Because in normal development each power of mind 
and body insists upon constant exercise. In other 
words the first law of growth and physical develop- 
ment is exercise. In the economy of Nature, it is 
this purpose which is served by the restlessness and 
activity of the child. To satisfy this motor activity 
is a study in itself. 

But, does not this instinctive love of play in the 
child serve other purposes? 

Yes, others that are vastly important ! In fact, the 
full purport of this scheme of Nature is often over- 
looked by those who surround the child. 

No mother would knowingly cause a child to be dull 
mentally. Yet, there is no doubt that many children 
are retarded mentally, to a greater or less degree, by 
unwise restrictions of their early life. 

What are some of the requirements of the intellect 
which are promoted by play? 

First, there is that most important acquisition of 
education — the habit of thought. The capacity of 
thought emerges very slowly. Very few people ever 
attain the full development of their intellectual powers. 
Education to a great extent consists in awakening 
these slumbering powers. Childhood's happy hours 
of play induce the habit of thought. Then there is 
concentration and attention. In no other way are 
these qualities developed so well as by games. It is 



236 THE CARE OF CHILDREN 

also through this medium that the child attains quick- 
ness of his intellectual powers and develops rapidity. 

So much for the intellectual side of this question, 
but has it not another very important function? 

Yes! The development of brightness and vivacity. 
The desire for play adds to the prosaic and common- 
place the gladsome tints which are born of the imagin- 
ation. Crush this desire in the child and you not 
only make him prematurely old but he will be slug- 
gish and feeble in thought. Youth is really the ap- 
prenticeship to life with play as the master workman. 
Well has it been said : "He who has been taught can- 
not be untaught unless he come as a little child." 

The sports of childhood leave a lasting impression 
on the emotional side of one's nature. What an asset 
is vivacity and responsiveness ! Who can estimate the 
value of a cheerful spirit or of a ready sympathy? 
Play cultivates the habit of gladness and appreciation ; 
it sparkles into the child's nature those graces that 
make the world kin and kind; it cultivates a joy 
in companionship and intellectual fellowship. Do not 
attempt to crush it but cultivate it. Nature intends 
this early impulse to quicken the sensibilities and stimu- 
late the lighter emotions; it intends that it shall in- 
fuse gladness, vivacity and sparkle into the activities 
of the mind as long as one lives. 

If a child is denied this rightful activity in sports 
and play; if premature sedateness and quiet are en- 
forced upon him, he will lose the buoyancy and cheer- 



THE ACTIVITY OF A CHILD 237 

fulness which should be his intellectual and moral 
tonic all his days. Suppress or extinguish this de- 
sire and you dwarf or distort valuable intellectual and 
emotional power. When we find one endowed with 
vivacity and charm, we are inclined to consider it a 
gift. There is no doubt it depends largely upon early 
environment when a child. For "if you would have 
life and beauty in the daily thought of the man, they 
must be put into his daily life when he is a child." 

The periods of play in a child are unmistakably 
marked. He will turn from one amusement to an- 
other as his years advance. However, free and unre- 
strained control defeats its own end, if certain limits 
of time are exceeded. In other words, after a certain 
time, amusements should occupy a secondary place; 
they should not interfere unduly with the education 
or the vocation which has been undertaken. 



CHAPTER XXXI 

THE CHILD'S SPEECH 

As we write there is with us a mental picture of 
a little girl of eight whose beautiful brown eyes filled 
with tears as her mother said in a voice none too kind : 
"Katherine, I have told you repeatedly that if you 
would take time to talk you would not make such a 
failure of it." It was then the mother imitated the 
child's stammering, in order, as she thought, to show 
her the ugly sounds. As the little girl turned, crushed 
and hurt, her mother said: "The distressing part of it 
is, she seems to get worse rather than better." And 
as we consider this mother's methods small wonder 
that her child's speech defect grew worse. 

All defects are not the same. Sometimes there are 
deformed dental arches or teeth not in normal aline- 
ment, or perhaps some part of the speech mechanism 
is absent, as is the case when there is a cleft palate. 
Imperfections caused by defective mechanism, how- 
ever, are easily recognized. The remedy for such 
disturbances is either surgical or mechanical inter- 
ference. But persons having speech defects of this 
nature are few in comparison with the large number 
who stutter and stammer. 

Children do not stammer as soon as they begin to 

238 



THE CHILD'S SPEECH 239 

talk. We must remember that a child is never born 
with this defect. While the speech mechanism is 
present at birth, speech is a faculty gradually and un- 
consciously developed. Stammering usually begins 
about the third or fourth year, and, unless some 
counter influence is brought to bear, is inclined to grow 
much worse through the school period. 

Stammering may be caused by fear of difficult 
sounds when speaking, or by nervous shock ; it may be 
caused by imitation, or by mental contagion when the 
child is in constant contact with some one who stutters, 
or most often by improper speech training. A child 
tries to imitate speech as he hears it around him. If 
the words are spoken slowly and distinctly, the child 
will try to talk in this way. On the other hand, if he 
constantly hears very rapid speech, he will try to speak 
fast and then he may stumble. 

There may be other causes for a child's stammering. 
The brain centers for the production of speech often 
do not keep pace with the centers where the mental 
images of words are formed. In other words, the 
child thinks faster than he can speak. 

The practise of making a child read or use words 
much too difficult to articulate, pronounce or under- 
stand may tend to make him stammer. 

And if the child is oversensitive, or if through ridi- 
cule or scolding, corrections are made destructive 
rather than constructive, the habit may not only be con- 
tinued but is frequently also driven in deeper. 



240 THE CARE OF CHILDREN 

Do not wait for the child to outgrow the habit. 
The golden opportunity for the correction of this 
speech defect is when it first appears. 

The attitude of the parents is most important, how- 
ever. The stammering child is a nervous child. It 
requires more than the normal effort for him to talk. 
This is naturally a greater drain upon his vitality. In 
addition to a well-selected diet and all kinds of out- 
door exercises, the child who stammers should have 
more hours of rest than are ordinarily allotted. 

Everything tending to produce psychic disturbances, 
such as anxiety, fear or intimidation, should be a- 
voided. And never should the clothing be so tight as 
to compress the respiratory or neck muscles. 

The child should not be made to feel that he is in 
any way different from other children. Do not call 
his attention to the fact that he speaks imperfectly. 
And does this mean he must not be corrected? 

Not at all. But let your corrections be constructive. 
Gently check the child. But do not tell him what not 
to do. Show him how to speak correctly. Lead him 
gradually into a more confident, more deliberate and 
careful mode of speaking. Never speak harshly. To 
do so makes the child conscious of his trouble ; it im- 
presses the difficulty more deeply into his mind and 
adds to his fear. These in turn may lead to loss of 
attention and interest and often to backwardness. 

Teach the child to think first of what he wishes to 
say, and then, when his thoughts are formed, to ex- 



THE CHILD'S SPEECH 241 

press them deliberately. In this way he will avoid the 
lack of coordination between thought and speech. 

If, when speaking, the child feels embarrassment, 
endeavor by means of affection and cheerful inter- 
course (devoid of compulsion) to supplant the fear 
of stumbling with confidence in his ability to speak 
freely. 

Always endeavor to prevent such a child from rush- 
ing into speech when he is excited. If he wishes to 
tell of an exciting happening, gently check him. This 
interruption may not necessarily take the form of a 
correction, but it must be effective enough to cause the 
child to stop and recover his normal poise; it must be 
made in a manner suggesting to the child calm and 
deliberate speech. Such an interruption may be some- 
thing like this : "John, mother never understands when 
one speaks to her hurriedly." 

When there is a speech defect or even a tendency 
toward one, the mother should take time each day to 
go over carefully with the child all the vowel sounds. 
These, as given by the Director of Speech Improve- 
ment, Department of Education, city of New York, 
are "Ah," "A," "Ee," "Aw," "Oh," "Oo" (the 
"a" used is that in the word make). The exercises 
should be practised standing. 

"Ah" should be produced with mouth open wide, 
the tongue flattened, with its tip against the lower 
teeth. Practise words: Father, papa, car, barn, star, 
Arthur, and so forth. 



242 THE CARE OF CHILDREN 

"A" must be made as a pure tone without a diph- 
thongal combination, as ayee. The tip of the tongue 
should touch the lower teeth, but the remainder of the 
tongue should be slightly arched above their level. 
Practise words: Ate, ache, blame, fate, make, baby, 
and so forth. 

"Ee." Care should be taken that the upper and 
lower teeth do not meet and that the sound be made 
not too thinly. The tongue is held in a position sim- 
ilar to that for producing "A." Practise words : See, 
meet, need, feel, eel, free, and so forth. 

"Aw." The lips are extended, with the mouth well 
opened, the tongue slightly convex. Practise words: 
Raw, saw, jaw, awning, lawn, gnaw, yawn, and so 
forth. 

"Oh." This is made with the lips round and pursed 
slightly forward. Avoid breaking the "oh" as though 
it were "o" plus "oh." The tongue is held flat (ex- 
cept for the back, which is very slightly raised), with 
the tip against the lower teeth. Practise words: 
Though, dough, and so forth. The same sound is 
found in words without the "oh," such as old, home, 
potato, and so forth. 

"Oo." The lips are rounded and pursed forward. 
The tongue is held in a position similar to that for pro- 
ducing "oh." Practise words: Ooze, spoon, too, 
and so forth. 

If the child has trouble in articulating these, the 
mother should have him observe the position of her 



THE CHILD'S SPEECH 243 

articulating organs as they act in producing the sounds. 
After the vowels then practise some exercises contain- 
ing letters and words with which there has been special 
difficulty. 

"Irrespective of the primal cause," says Dr. Fred- 
erick Martin, "it will be found that ninety per cent, 
of our cases have not their vocal organs fixed in the 
correct position for producing the sound which they 
are attempting to make. A boy may try to say 
'mother' with his mouth wide open ; an impossible po- 
sition for the letter 'm,' which requires that the lips be 
pressed together. 

"Therefore make him produce this sound correctly 
and, by breaking up the word into its component parts, 
or phonograms, see that he coordinates his vocal or- 
gans so as to give each sound in its proper sequence. 
In the beginning the process is slow and conscious, 
but very soon fear of speech itself is dispelled, con- 
fidence restored, and a new subconscious control of 
the organs instituted — all of which makes for perfect 
speech." 

There are also some tongue gymnastics that should 
be practised. These are : 1. Pointing tongue outward 
and upward to nose ; 2. Pointing tongue outward and 
downward; 3. Rotating around lips, beginning at 
right and going up; 4. Rotating, beginning at left 
and going up; 5. Raising tip of tongue; 6. Curling 
tip of tongue under; 7. Lalling — raising tongue to 
palate; 8. Expanding and relaxing the soft palate. 



244 THE CARE OF CHILDREN 

Tongue gymnastics are necessary in order to de- 
velop a faster coordination of the lingual muscles and 
a quicker response to stimuli, just as exercises to 
develop the muscles of the body are often necessary. 

Nursery rimes and poetry read aloud by the child 
are of value in helping to overcome a speech defect, 
but he should not be taught to a beat or in an unusual 
intonation of voice. It is also a mistake to attempt to 
correct stammering by conscious control of the breath, 
since the disturbance is not caused by a lack of breath. 
This is proved by the fact that stammerers, invariably, 
can sing without difficulty and singing requires greater 
lung power than speaking. 

Sometimes a child will use one letter for another as 
"t" for "c" or "k" for "g." This is usually either be- 
cause he has not acquired the use of the muscles at the 
back of the tongue which cause these sounds to vi- 
brate or when speaking he presses the tip of the tongue 
upon the gums of the upper incisors. If the child 
seems unusually slow in developing these sounds, hold 
down the tip of the tongue with a teaspoon and ask 
him to repeat the sounds he has been unable to pro- 
duce. This effort will, after a short time, show sur- 
prising results in overcoming the difficulty. 

And now to summarize, what do we gather? 

First. That a child's speech habits are formed long 
before he is able to take thought for himself. And 
that defective speech is often the result of careless 
habits acquired unconsciously in childhood. 



THE CHILD'S SPEECH 245 

Second. The speech mechanism is so delicate that 
it quickly registers the state of the nerves. This is 
shown by the fact that while speech is the last center 
developed in the evolution of the brain, it is the first 
faculty lost when we suffer shock in any form. 

Third. That the correction of a speech defect (barring 
defective mechanism and paralysis which frequently 
follows diphtheria, meningitis and infantile paralysis) 
is largely a matter of getting new habits adopted. 

Fourth. The way to rout out some undesirable ele- 
ment or force is to put some counter influence to work. 
Thus if haste in speech should be the child's weak 
point, gradually instil the opposite force — deliberation. 

The avoidance and elimination of speech conflicts 
and defects are not only an economic asset but also a 
physical and mental asset. It means that the speech 
center is the keystone or binding link of other areas of 
the brain and with its development we help in the 
proper training of other associated areas, such as hear- 
ing, memory, color and form. 

Stammering and stuttering in practically every case 
are curable if corrective measures are applied in child- 
hood. But if left until adult life there are few afflic- 
tions more difficult with which to deal. In fact, by 
this time it has become such a fixed habit, has so de- 
ranged the nerve mechanism, and the element of fear 
has become so pronounced, that the whole character 
often has to be reconstructed and the whole inner life 
reorganized. 



CHAPTER XXXII 

POSTURE THE FOUNDATION OF A 

child's HEALTH 

If we were asked to name one physical fault from 
which most perils to health arise, that one would be 
— wrong posture. That this is responsible for many 
and various evils is no longer doubted. In fact, its 
results are so far-reaching, to tell just where it will 
end or the amount of damage it will eventually do 
is impossible. 

And now what do we mean by wrong posture? 

We mean a downward displacement or depression 
of the various body parts. It is found in the droop- 
ing of the head, shoulders, ribs, in various types of 
spinal curvature and frequently there is a downward 
drooping with bulging at the lower waist line, of the 
abdomen. Any of these give the body the appear- 
ance of sagging downward, evidencing a condition 
which is not only the result of low vitality but which 
in turn tends to cause low vitality, thus creating a 
vicious circle. And now let us see just how this vi- 
cious circle is established. 

First. If the body is not properly poised with 
the chest raised (giving sufficient space for the res- 

246 



POSTURE 247 

piratory movement) the lungs cannot be properly 
developed, thus breathing is imperfect. 
Second. Unless the position of the body is such 
that not only adequate space exists, but proper mus- 
cular support is given, the abdominal organs cannot 
work rightly. 

Third. The pelvic organs cannot function nor- 
mally unless the position of the body is such that 
the abdominal organs are held in the abdomen and 
not crowded downward into the pelvis or upon the 
pelvic organs or their blood vessels. 

And what does all this mean? 

Simply that the more normal one's posture the more 
harmonious is the coordination of the body parts. 
That is, there is an equalized expenditure of force in 
respiration, in circulation, in digestion, hence in the 
rhythmic action throughout the body organism. To 
just what extent bad posture causes poor vitality is 
not definitely known. It is certain, however, that by 
assuming a good carriage, raising the chest and head, 
one feels better and vigor seems to be longer main- 
tained. It is generally recognized by physicians today 
that large varieties of disabilities, disorders and some 
diseases can be not only prevented, but by education 
and re-education in conscious control, they are often 
cured. 

Faulty posture is one of the most common defects. 
Instead of bad attitudes being the noticeable exception, 
the straight, easy carriage with balanced muscles is 



248 THE CARE OF CHILDREN 

conspicuous because of its infrequency. To be assured 
of this, stand some day on a busy street corner and 
observe the passing crowd. Even the non-critical ob- 
server may note many defects. The faulty types most 
often seen are : — 

The slump posture — head thrust forward, shoulders 
rounded, hips forward, knees slightly bent, and in all 
probability walking with a decided toeing out, which 
position causes a weakening of the structures of the 
foot. 

The second common type is practically the opposite 
of the slump. The individual stands with the knees 
straight, the anterior lumbar curve greatly exagger- 
ated, shoulders drawn up with the neck shortened. 
This type is most often seen in heavy individuals who, 
as a rule, have a large pendulous abdomen. 

It is in early youth, while the habits are in process 
of formation, that the most constructive work can 
be done toward training in physical grace and strength, 
which in all its beauty is only possible when the proper 
postures in standing, sitting and walking are main- 
tained. During this period it is comparatively easy 
to prevent and correct faulty attitudes. During this 
period, by muscle education, in other words, by exer- 
cising the right muscles, flat foot, narrow chest, round 
and stoop shoulders, one hip higher than the other and 
most cases of spinal curvature (those in which organic 
changes are not present) can be prevented. In fact, 
practically all deformity acquired in childhood with the 



POSTURE 249 

exception of that brought on by paralysis and tubercu- 
losis is due to someone's neglect. For by early and ap- 
propriate treatment most congenital deformities may be 
prevented from becoming fixed and developing into a 
severe grade. 

And now how shall we begin to build for good pos- 
ture? 

First, we must bear in mind that the body is kept 
erect by bones, muscles and ligaments. And as it is 
the muscles which keep the bones and ligaments in 
position, they must, in order to hold the body part 
up properly, be strong and in good tone. Muscular 
tone is dependent not only upon the use of the muscles, 
that is, bringing them actively into play, but upon the 
power of the nervous system which presides over their 
nutrition. For this reason, environment, good food 
and fresh air are primary essentials to good posture. 
In addition to these, as soon as the intelligence of the 
growing child will permit, he should be trained how 
to use his feet, how to breathe properly and should be 
shown what constitutes good posture. 

The feet, since they are the base of the bony skele- 
ton which supports the body weight, have an important 
bearing on the general poise and posture of the body. 
The correct position of the feet in standing and walk- 
ing is with the toes pointing straight forward. That 
is, if a line were dropped from the knee joint it ought 
to fall over the second toe. This position not only 
allows the weight of the body to be equally distributed, 



250 THE CARE OF CHILDREN 

but the feet have their greatest elasticity and the arches 
can perform their full function without strain. Ef- 
forts should be made to correct, while the muscular 
system is immature, any abnormal deviation from the 
straight foot in weight bearing. To do this (when one 
is dealing with a normal foot) is not difficult. It is 
simply a question of correcting wrong habits of mus- 
cular action. Sometimes it is only necessary to have 
the child practise walking a straight line with the feet 
parallel, toes pointing straight forward. Many chil- 
dren are prone to weakness of the muscles of the feet. 
This is true especially of those who in early life have 
suffered with malnutrition and rickets. The infec- 
tious diseases are also in many instances a predispos- 
ing factor, while frequently, among children who 
grow very rapidly, it is due to the fact that their mus- 
cular development has not kept pace with the body 
growth. These children, in addition to the natural 
exercises which in common with the development of 
other muscles tend to develop the foot muscles, should 
be encouraged in all kinds of dancing, especially gym- 
nasium dancing. This, since it brings into play all 
the foot muscles, is especially applicable to their devel- 
opment. Children with weak and flabby foot muscles 
also need some exercises especially adapted toward 
strengthening the muscles concerned with the mainten- 
ance of proper foot function. These exercises we have 
fully described in the chapter "The Care of Children's 
Feet" page 194. 



POSTURE 251 

Said a physician to a little boy who had been 
brought to his clinic: "J onnn y> how do you breathe, 
through your nose or through your mouth ?" 

"I don't breathe nowhere," was Johnny's answer, 
which as a matter of fact was almost true considering 
his very large tonsils and adenoids. This is true of 
many children, thus an important consideration is to 
be sure there is no obstruction to free breathing. Even 
after the removal of obstructions most children need 
to be taught how to breathe. Doctor S. Adolphus 
Knopf, the specialist on tuberculosis, is particularly 
keen for instructing every child in the art of how to 
breathe. When practising deep breathing, the correct 
standing position must be assumed. The correct po- 
sition is : — 

Feet slightly apart, toes pointing straight ahead, 
weight equally distributed between the feet. The hips 
should be straight, stomach drawn in (not evidencing 
effort) but showing the result of correct hip and chest 
posture. The chest should be held high with the chin 
lifted but not tilted. The shoulders should be dropped 
downwards, not forced back, as they will be back if 
the chest is high. Contrast this erect, natural and 
easy position with the poise of a child whose head is 
dropped forward, breast bone depressed, chest flat- 
tened, the neck muscles strained in the effort of trying 
to hold up the chest, a position which must, according 
to the law of gravity, unbalance and strain other parts, 
of the body. 



252 THE CARE OF CHILDREN 

After assuming the correct position, before an open 
window or out of doors, tell the child to fill the lungs 
(to inhale) and to try before expiration to make a 
slow mental count of five, exhaling sometimes explo- 
sively and sometimes slowly and steadily. If this is 
done regularly for a few minutes each day, little by 
little, the lungs will dilate, one will unconsciously in- 
crease the length of the inspirations and the slowness 
with which the air is expelled until gradually the 
count may be increased to ten or fifteen. And in time 
the desire for deep breathing will be constant. In 
other words, it will become a fixed habit. 

To be constantly reminding a child to hold up his 
shoulders, to stand or sit straight, will not accom- 
plish the desired result. After being reminded he 
will straighten up, most often in an unnatural posi- 
tion, but will instantly drop back into the old position 
as soon as his attention has been directed elsewhere. 
The child must be shown what constitutes correct 
carriage and must know how it feels to stand and sit 
in good posture. Often this can be accomplished as 
early as the 5th year. And as soon as the child can 
be made to understand, correct posture should be in- 
sisted upon at all times. Efforts to assume and main- 
tain good position should not, however, be made irk- 
some to the child. Give him the information in a lively 
interesting way, emphasizing such points as "head up," 
"chest high," "straight back," "straight hips," "lift 



POSTURE 253 

the waist up," "stretch the body upward" (stand tall). 
All of these elevation cues make for increased action 
of those muscles which hold the body erect. Playing 
soldier is an interesting way to impress the habit of 
good posture upon a little boy. He must, however, 
be impressed with the necessity of keeping the attitude 
of the soldier throughout. When the child seems un- 
able to assume a good position, that is, if the abdomen 
is poked outward or he does not "stand tall" these de- 
fects may, by placing him against the wall and pressing 
the hand over the abdomen in and upward and (while 
keeping the shoulders and hips against the wall) 
stretching the arms downward, be overcome. 

While holding the body straight and its parts 
adjusted and high, the actual strength of the muscles, 
(within reasonable limits), is important. Special ex- 
ercises for the purpose of developing the muscles 
should always be considered as distinctly secondary in 
importance to the conscious continued efforts to as- 
sume the right carriage. Well ordered play is the 
most natural way for a child to obtain physical exer- 
cise. Children should, however, be discouraged from 
indulging in one game to the exclusion of all others, 
as this will tend to develop only one set of muscles 
causing improper proportions. 

When such exercises as skating, dancing, lawn tennis, 
horse-back riding, running, rowing, wrestling, swim- 
ming and throwing a ball have failed, then one should 



254 THE CARE OF CHILDREN 

resort to other methods in an effort to train up various 
groups of muscles. For this purpose the simple set- 
ting up drills are beneficial. 

Deep breathing, while standing in correct position 
in the open air, is particularly to be encouraged. If 
when going out on a cold day there is a chilly sensa- 
tion, tell the child to take seven very deep breaths, 
which will send a glow all over the body. 

In giving exercises to children one should always re- 
member to begin with the easier ones, going on to the 
"harder only after the simpler ones have been thor- 
oughly mastered. The child should be very carefully 
taught and only in accordance with his understanding 
and strength development. He should not be given 
exercises when tired and they should not be continued 
long enough for him to become overtired. And al- 
ways it must be remembered that all exercises are use- 
less unless the proper position is maintained while 
they are being done. Also, that in order to get the 
benefit of an exercise, it must be done faithfully until 
the muscle has become firm and strong, just as an 
athlete in practising for some special event develops 
the muscle strength necessary to enable him to accom- 
plish it. Whenever it is possible, it is best to let the 
child have exercises properly supervised by a physical 
director. 

Childhood is the time for the most constructive work 
in correct posture — from the little one just able to get 



POSTURE 255 

around to those of the adolescent age. This is the 
period when the habits are in process of formation. 
This is the period to make correct posture habitual, 
making not only for better health in childhood but 
for excellent health in later life. 



CHAPTER XXXIII 

TUBERCULOSIS AND THE CHILD 

When I think of tuberculosis and the child, into my 
mind there comes a mental picture of many chil- 
dren I have known who were needlessly handicapped 
by lameness or physical deformity. Then I find my- 
self wishing that all mothers could be made to under- 
stand a few facts bearing on tuberculosis in childhood. 
For these few facts would not only save many from 
contracting tuberculosis, but would greatly reduce 
physical deformities among those who do. 

And what are these facts? 

First. Young children are easily infected with 
the tubercle bacillus. 

Second. Measles and whooping cough in early 
life are often followed by tuberculosis. 

Third. The germ causing tuberculosis is just as 
much at home in the bones as in lung tissue. 

Fourth. A fall or moderate injury is often a 
means of promoting tuberculosis of a bone or joint. 

Fifth. That in tuberculosis of a bone lameness 
and deformity are prevented by early recognition. 

The germ of tuberculosis is a tiny, millet-shaped 

bacillus which cannot be seen until magnified three 

256 



TUBERCULOSIS AND THE CHILD 257 

hundred times under the microscope and stained red. 
It is not hereditary. That is, it is practically never 
handed down from parent to child. But the child is 
much more easily infected with the germ than the adult. 
And why ? 

Because the blood of a child is not equipped with the 
same fighting power. The average grown person has 
considerable resisting power. It takes repeated and 
prolonged exposure; it takes unfavorable conditions 
of working and living to infect him. But this is not 
true in childhood. The chief sources of infection in 
childhood are: — 

First. From tuberculous parents or relatives kiss- 
ing and fondling the child. 

Second. Playing around on the floor of infected 
rooms and eating from dishes used by tuberculous 
people. 

Third. Through milk from tuberculous cows. 

Children should be kept out of sick-rooms, espe- 
cially should they be kept away from those who cough. 
The germ may be conveyed by kissing, coughing or 
sneezing in the child's face, or by using for him an in- 
fected handkerchief. 

Tubercular germs are sooner or later killed by the 
sunlight, but in the dust and dirt of infected rooms not 
reached by the sunlight, they remain alive and active 
for a long time. For this reason young children 
should not be allowed to play around on the floor. 
Whenever possible, a carpet sweeper should be used 



258 THE CARE OF CHILDREN 

in place of a broom. If the broom is used, the floor 
should be strewn with damp sawdust, wet paper, or 
something similar. The dust cloth should always be 
dampened. The dishes used by a tubercular person 
in the home should always be boiled. 

Cows frequently have tuberculosis and sometimes 
germs in large quantities get into the milk. Children 
are often infected from this source. Raw milk should 
not be given unless one is sure that the cow which 
supplied it is non-tuberculous. Milk from an unknown 
source should be pasturized. 

It has long since been shown that among all the 
diseases of childhood, measles and whooping-cough 
take precedence in the evolution of a predisposition for 
tuberculosis. Now what is the real significance of 
this? 

Simply, that the old theory that measles and whoop- 
ing-cough are trivial diseases and children might just 
as well have them, is a fallacy. Every effort should 
be made to prevent babies and young children from 
acquiring either of these. At best they have a de- 
bilitating effect, but the older and stronger the child, 
the greater the possibility of coming through un- 
scathed. If contracted, however, not only should the 
child be carefully watched during the disease but es- 
pecial diligence exercised until his nutrition has be- 
come as good as before the infection. 

In adult life the lung is the most vulnerable point 
of attack for the tubercle bacillus. This is not true 



TUBERCULOSIS AND THE CHILD 259 

of childhood. In early life the primary seat of tuber- 
culosis is in the bones, joints and glands, the lungs be- 
coming subsequently affected. Of all affections of the 
joints, tuberculosis is the most common. It is most 
prevalent from the second to the tenth year. 

Considerable explanation is necessary when saying 
tuberculosis of a joint is promoted by a fall or mod- 
erate injury. When a child is delicate, the tubercle 
bacilli are frequently present in the body but re- 
sistance has been such as to prevent them from gaining 
in any part a foothold. But when there is an injury, 
the blood is invited to the end of the bone where growth 
takes place. And if in the body there are tubercular 
germs they are carried to the part by the blood. Find- 
ing the bruised tissues and bones just the media neces- 
sary for their growth, it is there they colonize and be- 
gin to multiply. For this condition a mild injury is 
more favorable than a severe one. And why? 

Because with a severe injury, such as a fracture, 
even if the germs obtain access to the part, they are 
destroyed by the activity of the reparative processes. 
In other words, they do not find so favorable a field 
for growth as in the inflammatory exudate offered by 
the mild injury. 

All children fall once in awhile. It is something 
which cannot be avoided. The prevention of tumbles 
is not the point we wish to bring out. But if a child 
begins to walk lame, has a bad sitting posture, or 
gets up and down from the floor in an awkward, un- 



260 THE CARE OF CHILDREN 

natural way, as if trying to save from strain some 
part of the body, do not content yourself from day to 
day and week to week by thinking it is just a little 
stiffness from a tumble you know he has had. It 
may be a beginning tuberculosis. Seek at once the 
advice of a physician. It is a thousand times better 
to find you have been mistaken, than to have waited 
too long. 

Tuberculosis of a bone is sometimes slow in pro- 
cess but none the less deadly in its destruction of the 
bone cells. Its slowness sometimes causes the parents 
not to pay much attention to the trouble until the dis- 
ease has already reached its second stage — the stage 
of deformity. 

To the doctor and nurse, when a child is presented 
for treatment of a tubercular joint, not unusual re- 
marks are : — 

"He has been limping for some little time. I have 
noticed that the knee was swollen and thought it 
must be due to a slight sprain, but now he is unable 
to bend it." And in that most distressing condition, 
tuberculosis of the spine (sometimes called Potts' 
Disease) where in some instances there seems to be 
no end to the resulting deformities, we hear : 

"He has not walked naturally for some time and 
when I would take hold of his body under the arms 
to lift him, he would cry. Then I noticed this little 
knob on his back so felt sure something was wrong/* 
IWhen the disease has gone so far as this (to the stage 



TUBERCULOSIS AND THE CHILD 261 

of deformity) it means that the germs have gotten a 
strong foothold; it means many months and perhaps 
years of treatment. And to the eager questions: — 

Will the spinal deformity increase? And will the 
joint remain stiff? No doctor can definitely answer. 
For they are questions greatly influenced by general 
conditions, individual differences being marked. 

There are several positive signs which when taken 
in combination point definitely to a tubercular lesion 
of the bone or joint. These are: — 

Limp, or soreness, loss of appetite, night cries and 
loss of weight. 

If there is the slightest suspicion of a tubercular 
joint, rubbing or manipulating the joint in any way 
is the worst treatment one can give it. Put the child 
to bed and as much as possible secure absolute rest 
for the part. Do not rub or bend the joint or put any 
strain upon it from the weight of the body. At the 
earliest possible moment place the child in the hands 
of an orthopedic surgeon. By early and efficient 
treatment, the disease may be arrested and deformity 
or lameness prevented. 



CHAPTER XXXIV. 

NOW FOR HEALTHY HEARTS 

If asked with what disease mankind is most disas- 
trously affected, we believe nine out of ten people 
would answer tuberculosis or cancer. And why are we 
sure of these answers? 

Because for the last twenty years the medical pro- 
fession and public health workers have impressed upon 
the public mind the importance of waging constant 
warfare against the White Plague, and more recently 
we have become better acquainted with preventive 
measures against the other monster — Cancer. And 
yet these two enemies of the human race are by no 
means the greatest. There is towering above these 
another foe and this is Chronic Disease of the Heart. 

It was the cause of more deaths in New York City 
than resulted from tuberculosis and more than double 
those due to cancer. Chronic heart disease prior to 
19 1 6 had but little consideration as the subject of ad- 
ministrative control by Health Authorities. At this time 
the statistics set forth were hardly short of startling. 
For there loomed chronic heart disease which had 
claimed more than ten thousand victims. The exact 

262 



NOW FOR HEALTHY HEARTS 263 

figures for 19 19 as taken from the Board of Health 
Bulletin are: — 

Organic Heart Disease 10,421 

Tuberculosis 7>39^ 

Cancer 5J4 1 

But this was not the whole story. Physical exam- 
inations conducted by the Bureau of Child Hygiene dis- 
closed the fact that more than twenty thousand public 
school children were already handicapped by perma- 
nently damaged hearts. And also there was, without 
doubt, a much greater number of children suffering 
from other diseases, which if left uncontrolled, would 
result in permanently damaged hearts. From this evi- 
dence it became clear that the prevalence of heart dis- 
ease among school children and young people consti- 
tuted a public health problem of the first magnitude. 
It presented in all its phases a problem both medical 
and social. For not only must some way be found to 
aid those already handicapped but there was the big 
question of prevention. For it was clear that a con- 
siderable portion of this disability was distinctly pre- 
ventable. The importance of the question was so pres- 
sing there was incorporated an association called "The 
Association for the Prevention and Relief of Heart 
Disease/' The purpose of this scientific body was : — 

First. To coordinate the already available agen- 
cies for relieving those suffering from heart disease ; 
to gather information of all kinds bearing upon the 
affection and to develop and apply measures which 
would prevent the incidence of heart disease. 



264 THE CARE OF CHILDREN 

Second. To seek and provide suitable occupation 
and to promote the establishment of special dispen- 
sary classes for patients with heart disease. 

Third. To extend the opportunities for adequate 
care of cardiac convalescents and to urge the pro- 
vision of permanent institutional care for such car- 
diacs as are hopelessly incapacitated for self sup- 
port. 

Fourth. To encourage the establishment of as- 
sociations with similar objects in other cities. 

All this began five years ago. The acorn has been 
steadily growing. The Association now has in opera- 
tion thirty special cardiac clinics. They are provided 
with facilities and experts for the treatment of dis- 
eased tonsils, adenoids and teeth. Many of them have 
social service workers, thus enabling a follow-up sys- 
tem to be carried out in connection with cardiacs who 
have been discharged from hospitals. By reason of 
this observation and advice not a few people with 
damaged hearts are able to remain in good health 
while performing a reasonable amount of work. In 
some of the public schools a survey has been made and 
heart disease has been detected in children at an early 
stage, where not before suspected. Special cardiac 
classes on the ground floor have in some of the schools 
been organized. This is more or less of an experi- 
ment in order that the capabilities of these children 
may be determined and to find out to what extent 
ordinary school life is permissible. In addition, the 
Association has encouraged the establishment of con- 



NOW FOR HEALTHY HEARTS 265 

valescent homes for cardiacs, keeping in close touch 
with the work of such institutions as : — 

The Burke Foundation, The Zinn Home for Cardiac 
Children, The Mineola Home for Cardiac Girls, St. 
John's Guild and the Pelham Home for Children. 
Under the stimulus of the Association the number of 
beds available for cardiac convalescents has increased 
from seventy-five to over three hundred. 

And now what are the causes of so much heart 
trouble, especially among children? 

The causes may be grouped under Infectious Dis- 
eases and Improper Methods of living. Infectious 
diseases such as, scarlet fever, measles, diphtheria, 
syphilis and particularly rheumatism, seem to offer 
the most immediate point of attack. In early life rheu- 
matism of the acute inflammatory type often leaves 
a damaged heart. In children it is preeminently the 
great destroyer, in fact, may be mentioned as one of 
the chief causes of heart damage. Most people think 
of rheumatism as a disease affecting only the joints. 
This is a mistake. It affects nearly every organ of 
the body. In childhood, rheumatism attacks in par- 
ticular, the heart — producing heart disease, and the 
nervous system — producing chorea (St. Vitus's dance). 
While heart disease and chorea are recognized as 
diseases of the greatest importance, there are few who 
realize how frequently they occur as a result of rheu- 
matism. Chorea is very frequently associated with 
rheumatism of the heart. In other words, a child 



266 THE GARE OF CHILDREN 

with chorea very frequently also has heart disease. 
The heart disease found among children is generally 
divided into two classes: 

First. Organic heart disease, that is to say, per- 
manent disease of the heart valves or muscles. 

Second. The functional type. This is a type in 
which under the best possible conditions for im- 
provement, the child may be expected to recover. 

Unfortunately, most of the heart disease in early 
life caused by rheumatism persists through life. And 
why is this? 

It is because rheumatism leaves scars. And these 
scars damage the delicate valvular mechanism of the 
heart. Then it is the tendency of rheumatism to re- 
cur. Thus it may again and again attack the heart. 
We have said that rheumatism was preeminently the 
great destroyer. The natural question would be: 
What is the cause of so much rheumatism? 

The causes of rheumatism or how it invades the 
body are not definitely known. It is, however, un- 
doubtedly a germ disease, in which the infection en- 
ters the body through various avenues, such as dis- 
eased tonsils, adenoids or decayed teeth. It is prob- 
able also that infectious material may be swallowed 
with the food, or it may in some way find lodgment 
in the intestines. However this may be, it is cer- 
tain there is created somewhere in the body a focus of 
infection — an entrenchment of the enemy. From this 
point, at any time, especially when some other disease 



NOW FOR HEALTHY HEARTS 267 

condition has impaired the general health, the enemy 
may sally forth to wreck destruction. The germs 
from the infective process may stop in a joint or in 
many joints, causing arthritis; they may stop in the 
large muscles, resulting in muscular rheumatism or 
they may affect the heart lining, causing chronic dis- 
ease of the heart. 

"Of five hundred consecutive cases of rheumatism 
which came to me," says J. P. Poynton, M.D., London, 
"an analysis of the chief symptoms, on their first visit, 
showed that two hundred and forty-eight complained 
of painful joints and muscles, three hundred and fifty 
had heart disease, two hundred and forty-five had 
chorea, one hundred and thirty-seven tonsilitis more 
or less acute. Rheumatism then must not be looked 
upon as a disease in which a microbe has only to enter 
the patient like a penny slipped into a penny-in-the- 
slot machine, whereupon rheumatism will appear as 
does the box of matches. Unless the infection is viru- 
lent, and beats down all resistance, it requires a peculiar 
constitution and other attending circumstances before 
it produces this rheumatism and the process of infec- 
tion is a complex one." 

In childhood rheumatism must not be considered as 
an acute disease, at once prostrating the child with pain, 
swollen joints and fever. While in adults the disease 
often shows itself in this way, it is not true of child- 
hood. Rheumatism may in childhood resemble in 
one respect tuberculosis. And this, in that the attack 



268 THE CARE OF CHILDREN 

may not only be acute and obvious but also very grad- 
ual and insidious. 

It is clear that the greatest reduction of the inci- 
dence of heart disease will follow the prevention of the 
infection we call rheumatism. As to the focus of in- 
fection which gives rise to rheumatism, it is obvious 
that in childhood infected tonsils and decayed teeth 
are in a great measure responsible. 

In a group of eighty-two children with heart dis- 
ease, examined at the New York Post-Graduate 
Medical School and Hospital, fifty-seven had one or 
more decayed teeth and sixty-nine had badly infected 
tonsils. In a group of five hundred and ninety-six chil- 
dren examined for the Bowling Green Association, to 
determine the state of nutrition, there were twenty-three 
cardiacs or four per cent, and in the whole group only 
sixty- two had defective teeth and there were only 
forty-two with enlarged tonsils. In the cardiac group, 
therefore, decayed teeth are seven times and infected 
tonsils twelve times more frequent. Another direct 
effect of either defective teeth or diseased tonsils is a 
lowering of vitality and resistance to disease. This 
not only leaves the child a prey to the infectious dis- 
eases but leads to increased frequency of infection. 
And what is the real significance of all this? 

It means that the removal of adenoids and infected 
tonsils and the proper care of the teeth are the most 
direct and effective preventive measures not only 
against rheumatism but against all kinds of infections. 



NOW FOR HEALTHY HEARTS 269 

The value of out-of-door exercise and sufficient sleep 
in well ventilated rooms is also a preventive measure 
that may not be too highly appraised. 

It is particularly important, in order that its evils 
may be minimized, that the early symptoms of rheu- 
matism in childhood should be recognized. And what 
are some of the vague warnings that may suggest its 
approach. 

First. A sore throat with pain in the limbs. 
Second. Vague pains with occasional fever, often 
called "growing pains.'* 
Third. St. Vitus's dance or chorea. 

Nervousness of a type which causes a child to drop 
everything and change in disposition may also be a 
warning of approaching trouble. Children with com- 
mencing heart disease are gravely injured by any- 
thing which strains the heart. Although when rheu- 
matism attacks the heart there is no known way of 
preventing scars forming and damaging the valves, 
there is much that may be done to minimize the evil 
and strengthen the heart. The throat, the tonsils and 
the teeth require attention. Great care must also be 
exercised to see that these children are prepared for 
vocations that do not defeat the purpose of remedial 
treatment. This means of course, occupations that 
will prevent acute attacks of heart overstrain, since 
these not only are distressing and dangerous but often 
lead to permanent invalidism. 

In addition to the objects which the name of the 



270 THE CARE OF CHILDREN 

Association implies, "Prevention and Relief, " their 
aim is to teach during the school age those children 
affected with organic cardiac conditions and to guide 
them intelligently into the most suitable vocations. 
This is a big work. It promises much. For it must 
inevitably lead not only to a lessening of those dis- 
eases which attack the most vital organ in the body 
but to the prevention of invalidism and the conse- 
quent economic loss of those handicapped by damaged 
hearts. 



CHAPTER XXXV 

THE PREVENTION OF DIPHTHERIA (THE 
SCHICK TEST ) 

Twenty-seven years ago, antitoxin, a serum con- 
ferring immediate passive immunity in diphtheria, 
was given to the world. It was one of the most note- 
worthy achievements in medical science. The mortal- 
ity from diphtheria was gradually reduced from about 
seventy-five per cent, to ten per cent. At this point, it 
has, however, remained more or less permanent. And 
what does this ten per cent, mortality mean? 

It means that in New York City alone there are each 
year not less than fourteen hundred deaths from diph- 
theria, while the number developing this disease is 
about ten times as great — namely, fourteen thousand. 
It means that in the United States the calculated yearly 
mortality from diphtheria is from twenty to twenty- 
two thousand, while the total illness from this infec- 
tion is from one hundred and fifty thousand to two 
hundred thousand cases. 

When we think of impaired health and mortality 
from diphtheria it is to think of the children. For 
eighty per cent, of the deaths from this disease occur 
under five years of age. 

The natural question at this point would be : 

271 



2J2 THE CARE OF CHILDREN 

Why with a remedial agent conferring immediate 
passive immunity, as is the case with antitoxin, should 
this relatively high mortality from diphtheria remain 
more or less constant? For we know that if in every 
case antitoxin could be applied early enough, the mor- 
tality from this disease could be reduced to nil. 

There are two causes for this, either one or both of 
which may be factors : They are : — 

Delayed application for treatment and delayed rec- 
ognition of the disease on the part of the physician. 
And what is the significance of this? 

Simply that while the use of antitoxin has robbed 
diphtheria of much of its terror, this disease is still no 
small menace to the health and lives of the children. 

Almost eight years ago, Schick — a scientist — dis- 
covered by means of a simple clinical test called the 
Schick Test, that certain people are quite immune to 
diphtheria and cannot catch it, while others are quite 
susceptible to the infection. It has been shown that 
three-fifths of all children between the ages of six 
months and three years are susceptible. The figures 
for the different ages are : — 

Under three months 15% 

Three to six months « 30% 

Six months to one year 60% 

One to two years 60% 

Two to three years 60% 

Three to five years 40% 

Five to ten years 30% 

Ten to twenty years ■ . ... . . . 20% 

Over twenty years ., 12% 



THE PREVENTION OF DIPHTHERIA 273 

The reason some children are immune and others 
susceptible is probably due to an inherited tendency to 
make antibodies (antitoxins) which, as the child 
grows older, develops. In fact, the whole problem of 
susceptibility goes into the big question of general or 
acquired immunities. We know that to a remarkable 
extent we manufacture in our bodies immunities (anti- 
bodies) against certain diseases. While in many in- 
stances these -are acquired by contracting and recov- 
ering from the disease itself, immunities are also 
acquired as a result of the necessity our bodies may be 
under of fighting off disease. That is, when our body 
cells are strong enough to overcome the disease cells, 
we become gradually inoculated against the disease. 

The immunities or antitoxins which a mother de- 
velops are transmitted to her children. As a general 
rule the child does not retain these longer than six 
months. And why is this? 

It is due to a change in the chemical composition of 
the body. While at birth the chemical composition of 
the baby's body is the same as the mother's, this is not 
true after a time. Thus the child eventually has to 
create its own disease-resisting antibodies. 

The antitoxins conferred by the mother against 
diphtheria are in most instances lost after the first 
six or nine months. And this explains the high mor- 
tality from this disease between the ages of one and 
five years. 

We have said that by means of a simple test, called 



274 THE CARE OF CHILDREN 

the Schick Test — it can be ascertained if one is sus- 
ceptible to diphtheria. And what is the Schick Test ? 

It consists of injecting into the skin, usually at a 
point just below the inside of the elbow, a tiny drop 
of a prepared fluid. To those who are immune to 
diphtheria, this has no effect. If one is susceptible 
to the disease, however, there appears within from 
twenty-four to thirty-six hours, an area of redness at 
the point of injection which is about the size of a five 
cent piece. Within the next two or three days this be- 
comes more marked and leaves for a time, on fading, 
a brownish area. This test is practically painless. 
There are no after effects, with the possible exception 
of a slight itching at its site, and even when positive, 
there is no scar formation or permanent mark. But 
this is not all. For having determined upon the sus- 
ceptibility of a subject, it is possible to actively im- 
munize (protect) such a one against the disease. And 
here one might well say: It has, since the introduc- 
tion of antitoxin, been possible to protect one against 
diphtheria. Quite true. The administration of anti- 
toxin to a child exposed to diphtheria protects within 
a few hours, but this produced immunity disappears 
in less than three weeks. There is, however, an im- 
munity which lasts for years and possibly a lifetime. 
And how is this brought about? 

By the administration of a preparation known as 
toxin-antitoxin. One injection of this preparation 
brings protection to about seventy-five per cent, of 



THE PREVENTION OF DIPHTHERIA 275 

those who have shown a positive test. The usual way 
of giving toxin-antitoxin is in three injections at inter- 
vals of a week. This immunity reaches its full effect 
in two or three months, and as we have said lasts for 
years and possibly for a life-time. 

After the injection of toxin-antitoxin, there is usu- 
ally some local and constitutional reaction. This re- 
action is similar to typhoid vaccine but of less severity. 
Children between the ages of one and ten vary accord- 
ing to their age in the amount of reaction, the young- 
est showing the least and the oldest the most. All 
disturbance is over, however, within from twenty-four 
to seventy-two hours. 

After seven years of intensive study with reactions 
from the Schick Test, the Research Laboratory of the 
Health Department of the City of New York, have 
reached the conclusion that this is a most valuable and 
accurate test. They began sometime ago the task of 
testing the entire school population of the city, pro- 
tecting those against disease whom the test showed 
to be susceptible. 

The tests among the public school children have 
shown that from thirty to sixty per cent, are suscep- 
tible to diphtheria, while in some of the private schools 
it has been shown that as many as seventy-nine to 
eighty-five per cent, of the children could easily fall 
victims to this disease. A particularly striking fact 
was brought to light by the application of the Schick 
Test among school children, namely : 



2j6 THE CARE OF CHILDREN 

That children in schools in better localities, where 
there was less overcrowding, had a greater predispo- 
sition to diphtheria than those in what might be called 
tenement-house districts. In a private school, not 
crowded and where children of the well-to-do attend, 
it was found that seventy-two per cent, showed a 
positive reaction to the test for susceptibility to diph- 
theria, while in another similar school seventy-nine 
per cent, showed positive. In a rural school in New 
Jersey, the percentage was abnormally high, showing 
eighty-five per cent. And what is the significance of 
this? 

Simply that the average city child has a greater re- 
sistance to the common infectious diseases, such as 
diphtheria, scarlet fever and measles, than has the 
country child. This may be due to either one or both 
of two causes: 

First. They are bred of less susceptible stock by 
reason of having experienced and survived these 
diseases. 

Second. The tissues of those who live in the coun- 
try not coming in contact to such an extent with 
these diseases so common in the city do not become 
accustomed to producing the antibodies required to 
overcome them. The country child is therefore, 
more susceptible than the city child. And this 
brings us back to the big question of immunities 
acquired as a result of the necessity our bodies may 
be under of fighting off disease. 



THE PREVENTION OF DIPHTHERIA 277 

Diphtheria is the most uncertain and treacherous 
disease with which physicians have to deal. It may be 
transmitted by direct contact from the sick to the well, 
by drinking cups or eating utensils which have been 
used by the sick, by contaminated clothing, toys and 
books or it may be transmitted by a "carrier," that is, 
one in whose throat the germs may be present. A 
"carrier" may have had the disease and recovered from 
it or he may have sufficient resistance to overcome the 
germs himself but could easily transmit them to others 
who having less resistance might contract the disease. 
A child may develop diphtheria within twenty- four 
hours after exposure or the attack may be delayed for 
a month or six weeks. One attack does not protect 
against another. While there is some evidence that 
a degree of immunity is established, this is probably 
not effective after a few months have elapsed. 

And now what are the advantages of the simple 
test which we have described ? 

First. It enables the physician and the parents to 
know whether the child is susceptible or immune to 
diphtheria. 

Second. In case of an outbreak in the home or in 
the school, the unnecessary injection of antitoxin 
and long periods of quarantine are avoided. For 
by means of this test one is enabled to select the 
susceptible children, thus it is possible to rapidly con- 
trol an outbreak of diphtheria. 
Third. The immunization (protection) of all chil- 



278 THE CARE OF CHILDREN 

dren from diphtheria is essential in bringing up a 
diphtheria-immune population. 
Fourth. Diphtheria is widely prevalent. The 
mortality among children from one to five years 
from this disease is almost as great as from measles 
and scarlet fever combined. The number of chil- 
dren left with crippled hearts by reason of this 
affection, it is difficult to estimate. For of all the 
acute infections, diphtheria is most prone to attack 
the heart muscle. 

After testing more than fifty-two thousand children, 
the Director of the Research Laboratory, Department 
of Health, New York City, and his associates have 
reached the conclusion that the solution of the diph- 
theria problem depends upon a general, active im- 
munization of all children of pre-school age, the Schick 
Test, in order to simplify matters, being omitted. 
This conclusion is due to the high proportion of posi- 
tive Schick reactions in children from six months to 
five years of age and the corresponding high sick rate 
and mortality from diphtheria in this age group (80 to 
85%) of all diphtheria cases. 

The means is now at hand whereby diphtheria scares 
may become a thing of the past. Parents should se- 
riously consider protecting their children against diph- 
theria. Take this question up with your physician. 



CHAPTER XXXVI 

POLIOMYELITIS (INFANTILE PARALYSIS ) 

Somewhat as the Angel of Death struck the Egyp- 
tians, when (according to Moses) the first born of 
every household lay dead in the morning was the way 
"a pestilence which walketh in darkness and wasteth 
in noonday" desolated some communities. In the 
summer of 19 16 sweeping through New York 
City, taking a death toll of more than twenty-four 
hundred, leaving thousands of others with a blighting 
deformity, Infantile Paralysis moved on into other 
states, laying its blighting hand upon no less than 
twenty-seven thousand victims, mostly children. 

The Infantile Paralysis epidemic in 191 6 made a 
profound impression upon the public for three rea- 
sons : — 

First. The severe and dramatic results seen in 
those attacked. 

Second. The policy of absolute frankness as to 
the limitations of scientific knowledge. 

Third. The publicity given to the fact that in 
such epidemics the problem is almost as much social 
as medical, since they cannot be eliminated and pre- 
vented without public cooperation. 

279 



280 THE CARE OF CHILDREN 

Few diseases are more terrible than Infantile 
Paralysis, which all too often leaves its victims crip- 
pled for life. And in order that children may be 
guarded with every precaution from its blight, it is of 
supreme importance that every person should know 
something regarding its sinister character, and, so 
far as is known, its methods of dissemination. 

Infantile Paralysis — the name "Acute Anterior 
Poliomyelitis'' describes it far more accurately — while 
recognized and described as early as 1840, did not 
until 1907 become a serious problem in America. At 
this time a pandemic of the disease arose in the United 
States, France and Germany. This led to redoubled 
efforts in the fields of research, in which were em- 
ployed the more subtle channels of later bacteriologi- 
cal methods. While comparatively little is yet known 
concerning the disease, this research work, led by 
Doctor Simon Flexner and his associates, has estab- 
lished certain definite facts : — 

First. The disease is due to a micro-organism so 
minute that it passes with great readiness and with 
little or no loss of energy through the pores of the 
densest and finest porcelain filters. 
Second. The entrance of the micro-organism or so 
called filterable virus into the system is by way of 
the mucous membrane of the nose and throat. 
Third. The same portal of entry can and probably 
does act as the pathway of exit for the germ to be 
transmitted by contact or carrier to new fields for 
reinfection. 



POLIOMYELITIS 281 

Fourth. The virus through the blood stream 
reaches the spinal column, there producing lesions 
which cause a more or less degeneration of the sens- 
ory and motor cells. 

The name "filterable virus ,, is applied to some 
disease-producing organisms, because they are so tiny 
as to be beyond the range of microscopic vision and 
pass through the pores of the densest and finest filters. 
While there is some doubt as to whether the virus 
causing Infantile Paralysis has actually been seen, 
there is conclusive evidence that it is a living organism, 
since quantities as small as one one-thousandth to one 
one-hundredth of a cubic centimeter of the filtrates, 
suffice to cause the disease in monkeys, after the usual 
incubation period (time elapsing between implantation 
of contagion and the appearance of disease) when in- 
jected into the brain. 

"That the virus is a living organism must be con- 
cluded," says Doctor Flexner, "from the fact that 
such minute quantities of it suffice to carry infec- 
tion through an indefinite series of animals," add- 
ing: "We have propagated the virus now through 
twenty-five generations, representing twenty-five 
separate series of monkeys, and as many removes 
from the original human material supplying it, and 
the activity of the virus for the monkeys has 
increased rather than diminished in the course 
and as the result of the successive transplanta- 
tions. . . ." 

Infantile Paralysis is most frequent during the dry 
summer months, from June to October, although, 



282 THE CARE OF CHILDREN 

cases are reported throughout the year. While pre- 
eminently a disease of early childhood — the greatest 
number of victims being between one and five years — 
it does not wholly spare older children or even adults. 

As to the symptoms, there is no one classification 
that will cover all cases, since the disease occurs in 
many different forms and in varying degrees of sever- 
ity. Its multiform character is due to the fact that the 
virus by affecting different parts of the nervous sys- 
tem causes different symptoms. In general, they 
are those of an acute infection. In many instances 
gastro-intestinal symptoms predominate. While in 
others, there may be stiffness of the neck, bending of 
the head, sweating, marked nervous irritation and 
general sensitiveness. 

The chief terror of Infantile Paralysis lies in its 
appalling power to produce deformities. This is due 
to the impairment of the motor function of certain 
of the cells controlling muscular action — most often 
in the legs. The motor paralysis appears after the 
acute onset. Generally, this paralysis reaches its max- 
imum about the second day, hardly ever later than the 
sixth day. 

It is not generally known that there is a type of 
Infantile Paralysis, called the "abortive type," which 
very often is not brought to the attention of a physi- 
cian, thereby resulting in dissemination of the disease. 
This is called the "abortive type" because true Infan- 
tile Paralysis of the paralytic type does not develop. 



POLIOMYELITIS 283 

There may be an illness resembling an acute febrile 
attack, lasting hardly longer than twenty- four hours 
before the beginning of convalescence. While many 
of these cases show suspicious weakness of the muscles 
during convalescence, happily for the child the usual 
paralysis does not develop and the little one is allowed 
to be about. While such an outcome is indeed fortu- 
nate for the child, he is none the less dangerous to 
those with whom he comes in contact. Striking in- 
stances of this type of the disease were encountered 
by doctors and nurses in the house to house inspection 
made in some of the crowded districts during the 
19 1 6 epidemic. Children were frequently found go- 
ing around showing a slight limp. The history of 
each case always brought out the fact that the child 
had been ill. As the mother would describe it : "He 
has been a little sick, but not enough to stay in bed." 
But what did this mean ? 

It meant that the child in being about at a time 
when the weakened muscles should have been at rest, 
was threatened with permanent injury; it meant also 
that such a child was a center of contagion for other 
children. In sections where the disease has been in 
evidence, the appearance of symptoms in a young child 
suggestive of an acute infection is always suspicious 
Particularly is this true if accompanied by sweating, 
nervous irritability, neck stiffness and general sensi- 
tiveness. To be on the safe side, all children having 
fever should be isolated pending the diagnosis. 



284 THE CARE OF CHILDREN 

During an epidemic of the disease, children should be 
kept from crowds and all public places of amusement. 
They should not be allowed to go to parties, picnics 
or other places where they will freely mix with other 
children, some of whom may already be infected or 
may be carriers of the virus. This cannot be too 
forcibly emphasized. Well do we remember a tragic 
incident of 191 6. A little girl — an only child — living 
in a town in New York State, where some cases of 
poliomyelitis had been reported, was being taken by 
automobile to the country. While passing through a 
town in another state, the mother decided the child 
needed some additional clothing, so ventured with her 
into a department store. This little girl within the 
usual time after exposure developed poliomyelitis and 
is today a pathetic cripple. While no one can say 
absolutely that the child, while in the crowded store, 
was exposed to the virus of Infantile Paralysis, it 
was a grave risk to take. 

Especial care should also, during an epidemic, be 
given food, particularly such food as is consumed 
uncooked. This should not only be carefully selected 
but should be well cleansed with pure cold water. 
Food should be carefully protected at all times 
against contamination from dust, flies or other insects. 

Measures tending to prevent bringing what might 
be infectious dust and dirt into the household, tracking 
this into carpets or rugs, especially into rooms where 
young children may be playing around is during an 



POLIOMYELITIS 285 

epidemic an important factor of prophylaxis. To 
avoid this, there should be outside the main living- 
room a broom or cloth for the shoes and one for the 
clothes, each person before entering, taking care to 
remove as thoroughly as possible the street dust from 
the clothes. 

It is not definitely known how the infecting organ- 
ism of Infantile Paralysis is transmitted. While vari- 
ous agencies have been accused of being the carrier, 
their culpability as the medium of transmission has 
not been proven. It is Doctor Flexner's belief that 
the nose and throat secretions of infected persons dry 
and, as dust, become potent sources of infection and 
that "house flies act as passive contaminators since the 
virus survives on the body and within the gullet of 
these insects." Careful clinical observation has pretty 
generally substantiated these theories as modes 
of infection. That the organism may be conveyed 
directly by kissing, sneezing, etc., is no longer ques- 
tioned. 

There is as yet no known method of aborting the 
affection or limiting the paralysis, although intra- 
spinal injections of the blood of recovered persons have 
been administered with the hope of perfecting an anti- 
serum. This is, however, as yet wholly in the experi- 
mental stage. 



CHAPTER XXXVII 

QUARANTINE AND OTHER MEASURES AGAINST 
INFANTILE PARALYSIS 

Similar to a fire beginning in a dry forest, is epi- 
demic Infantile Paralysis — easy to handle if discov- 
ered in time — but once gaining momentum, a terrible 
struggle ensues before it can be conquered. Like so 
many other scourges, if the world could be cleansed of 
poverty, ignorance, carelessness and superstition, there 
would be but little need to hunt down mysterious 
germs stopped by no filter and disclosed by no micro- 
scope. But since even the beginning of the Elysium 
is not yet, epidemics may be prevented only by an 
awakening of the public conscience as to the vital 
necessity of cooperation in the enforcement of health 
and sanitary regulations. 

As to quarantine and other measures against Infan- 
tile Paralysis : 

The committee on Poliomyelitis of the State and 
Provincial Boards of Health meeting in Washington 
in April, 191 7, suggested certain minimum require- 
ments for control of the disease. Among these were : 

First. That an isolation period for a patient of 

286 



QUARANTINE 287 

not less than two weeks nor more than three weeks 
from onset be required, unless the temperature has 
not returned to normal in the meantime. 

Second. That children of the same household in 
contact with a patient be excluded from places of 
public assembly for a period of fourteen days from 
last date of contact, as determined by the health of- 
ficer. 

Third. That an adult of the household, if patient 
is properly isolated, may continue his vocation, pro- 
vided it does not bring him into contact with chil- 
dren at any time. 

When Infantile Paralysis develops (or even if it is 
a suspected case) call in a physician and avoid contact 
with other members of the family. If medical and 
nursing care can be given and facilities are adequate 
for proper isolation, the child may be cared for in the 
home. 

The room selected should be quiet and should, if 
possible, adjoin a bath-room. It should be freed from 
excess furniture, carpets and hangings and must be 
efficiently screened for under no circumstances must 
flies or other insects have access to the patient or his 
excretions. If two nurses are required, two isolating 
rooms will be necessary, one to be used as a sleeping 
room. That the floor be bare is very desirable since 
it should be mopped every second day with carbolic 
solution (1-40) or at least sprinkled with some 
dampened material (such as sawdust) that no 
dust may arise when cleaning. The dusting should 
also be done with a dampened cloth. The necessity 



288 THE CARE OF CHILDREN 

for keeping dust in obeyance in any infectious disease 
cannot be over emphasized. This inference is based 
upon the most fundamental teachings of bacteriology : 
That bacteria cling to moist surfaces, and while in 
a moist condition cannot be swept into the air or car- 
ried from one point to another, save by animal agents. 
When allowed to dry, however, as they must in dust, 
they may when scattered abroad, become a potent 
source of infection. For this reason dust should be 
reduced to a minimum and removed without scatter- 
ing. 

When arranging for isolation, some of the earliest 
necessities are: — 

One large foot tub for use in disinfecting the bed 
clothing 

One medium sized covered pail into which the water 
used for bathing purposes may be disinfected be- 
fore being carried to the toilet 

Two wash basins, one to be used for bathing pur- 
poses, the other for cleansing the hands after car- 
ing for the patient 

One hand brush for use in cleansing the hands after 
contact with the sick or any of the excretions 

Several large paper bags in which may be placed 
gauze or other refuse for burning 

One round basin for use in washing dishes 

One mop and a small dusting basin 

A large glass bottle or some container for carbolic 
solution. 

In addition there should be, if possible, some way 
of providing hot water without the necessity of going 



QUARANTINE 289 

to the kitchen. If a room can be had adjoining a 
bath-room, isolation can be made much simpler. The 
linen can then be disinfected in the bath tub and the 
stationary wash basins may of course, be used for 
cleansing the hands. Anything taken into the room 
should be left there, unless it may be boiled or thor- 
oughly cleansed and exposed to the sun. 

The nurses or attendants should take entire care 
of a child ill with Infantile Paralysis and no one else, 
save the physician, should be allowed in contact. 
When entering the room and before approaching the 
bed, the clothing should be protected by a long gown 
or an apron with sleeves. This should hang just in- 
side the sick-room, easily accessible upon entering. It 
should not be worn outside the room. 

Cats, dogs and all other household pets must be 
excluded from the sick-room. 

The discharges from the mouth and nose should 
be received in gauze, old linen or paper handker- 
chiefs, deposited in a paper bag and burned at least 
once a day. Bowel excretions should be promptly dis- 
infected with Chloride of Lime or other disinfectant 
designated by the physician. This is most important 
since the virus has been detected in the secretions not 
only of the nose and throat but of the intestines of 
patients suffering from either true Infantile Paralysis 
or the abortive type. 

After handling the patient or any of the discharges, 
the hands should be promptly washed with hot water 



290 THE CARE OF CHILDREN 

and soap, using a hand brush. To be effective this 
must not be a perfunctory washing, but should be very 
thorough. The attendant should also wash the hands 
similarly before leaving the room and especial care 
should be used in cleansing the hands before going to 
meals. 

The soiled linen should, before it is taken away, 
be soaked twelve hours in a 1-40 solution of carbolic 
acid. (See page 108, "How to Care for Infectious 
Diseases in the Home.") It should then be wrung 
from the solution, transferred to a covered pail and 
boiled separately from the clothes of other members 
of the family. 

The dishes used in the sick-room should be left 
there. The refuse should be scraped into a paper bag 
and burned. If too many dishes accumulate, they may 
after a thorough washing in hot water be trans- 
ferred to a pan which has been left at the door, taken 
to the kitchen, covered with cold water and boiled. 
After dishes have boiled for five minutes it is per- 
fectly safe to use them. 

In caring for one ill with any grade of Infantile 
Paralysis, it is particularly important to secure for the 
sick child the maximum degree of rest and quiet. The 
disease is really an inflammation of the spinal cord 
associated with more or less hemorrhage, and re- 
covery of the spinal centers is obviously hastened by 
rest and quiet. 



QUARANTINE 291 

When the isolation has been terminated, the entire 
body of the child should be bathed and the hair 
washed. The child should then be wrapped in a sheet 
(which has not been in the sick-room) and carried to 
another room. The floors and woodwork of the va- 
cated room should then be thoroughly cleaned with hot 
water and soap. The mattress and pillows should be 
brushed with a whisk broom which has been lightly 
dipped into carbolic solution, then spread over chairs, 
while the room is sunned and aired for at least twenty- 
four hours. 

Nowhere is the old saying "Make haste slowly" 
more applicable than to the convalescent stage of In- 
fantile Paralysis. The greatest danger is fatigue of 
the weakened or paralyzed muscles. These muscles 
are sick with deranged nerve and blood supply; they 
therefore tire easily, not only by active but also pas- 
sive use, — manipulation, massage, electricity and 
muscle training. This needs emphasis since parents 
very often are led, through anxiety and the fact that 
much is heard of wonderful recoveries under certain 
treatments, to disregard doctors' instructions. It must 
be remembered that while massage, electricity, manip- 
ulations and muscle training, all have a place in the 
treatment of weakened and paralyzed muscles re- 
sulting from Infantile Paralysis, no two cases may 
be alike and the amount of such treatment beneficial 
to one may be detrimental to another. For this 



292 THE CARE OF CHILDREN 

reason, all such applications should be given by a 
trained attendant under the guidance of a physician. 
The convalescent period of Infantile Paralysis ex- 
tends practically over two years, that is, the greatest 
gain is to be made during this period. 



CHAPTER XXXVIII 

THE RIGHT FOOD FOR SCHOOL CHILDREN 

Not long ago it was brought out through medical 
examinations made in fifteen cities of the United States 
that of 547,909 school children examined, not less than 
29,019, or between five and six per cent., were not 
only underfed, but were suffering in health from the 
results of underfeeding. 

School-days cover most of the growing period of 
a child's life. It is during this time that the constitu- 
tion is established for the remainder of life. When 
we consider that bodily and mental growth are making 
their demands at the same time, that extra demands are 
made upon the nervous system, the metabolic changes 
of the body being thereby greatly increased, we can 
readily understand the importance of maintaining a 
high state of nutrition. 

Furthermore, in a malnourished child the maximum 
physical and mental growth can not be attained. The 
mentality is dulled and all the normal processes of life 
lowered. He lacks alertness. It is difficult for him 
to pay attention, and there is a reduction in vitality 
which makes him more susceptible to disease. In 

293 



294 THE CARE OF CHILDREN 

fact, a breakdown in health while at school is quite as 
often due to faulty nutrition as to overwork. 

It is not alone the children of the poor who suffer 
from malnutrition, but many who are reared in homes 
of plenty. This being true, the natural question 
would be : Why are they malnourished ? 

Because they do not receive the right quantity and 
quality of food to maintain the proper standard of 
growth and development. 

Many children hurry to school in the morning, having 
eaten little or no breakfast or having had breakfast at 
a very early hour. If a luncheon be eaten at all, often 
it is not adequate to supply the needs of a growing 
child. Then there are many parents who think they 
have solved the problem when they have given their 
children small amounts of money with which to buy 
luncheon. But what kind of luncheon do they buy? 

Usually such things as pickles, cakes, cheap candies 
and other injurious and indigestible food. More- 
over, this food is very often bought from push-cart 
venders or street stands where it has been exposed 
to dirt and filth, and is often dangerously adulterated. 
After school these children hurry home and hastily 
bolt a cold luncheon at two or three o'clock, which im- 
pairs their appetite for supper at six. With a regime 
of this kind over a long period, is it at all surprising 
that the child becomes malnourished? 

The essentials of diet for the child are an abun- 
dance of simple, easily digested foods carefully prepared 



SCHOOL CHILDREN 295 

and of sufficient variety to form a correctly balanced 
diet, that is, the three meals must provide in reasonably 
correct proportions all the important nutrients. To 
do this most effectively, experts of the Department of 
Agriculture tell us that the three meals must supply 
the child with sufficient food from: 

1. The cereals or starchy foods : 

Breads, cereal mushes, ready-to-eat cereal 
breakfast foods. 

2. The protein rich foods : 

Milk, lean meat, fish, poultry, cheese, eggs, 
dried beans, cowpeas, peanuts, almonds, wal- 
nuts and other nuts. 

3. The fatty foods: 

Butter, cream, bacon, salad-oils. 

4. Fresh vegetables and fruits: 

Potatoes, greens, lettuce, asparagus, green peas, 
beans and all kinds of fruits either raw or 
cooked. 

5. Simple sweets: 

Cakes and cookies, not made of rich ingredients, 

plain candies, honey, preserved fruits and 

simple desserts. 

It is seldom possible to provide at one meal all the 

materials necessary for the growing body, so what 

is omitted in one meal should be supplied by one 

of the other meals. 

The school child should, as a rule, have his breakfast 
at seven-thirty, so that he may never be obliged to 



296 THE CARE OF CHILDREN 

hurry in eating in order to be in time. Of course, 

with children in rural districts, where it is necessary 

to drive long distances, breakfast must be earlier. 

The mother should in all cases take care that it is a 

substantial meal. 

An ideal diet schedule, taking in all the principal 

food constituents, varied from day to day, would be: 

Breakfast, 7:30: 

Fruit, well-cooked cereal eaten with cream and 

sugar, egg, soft-boiled or poached, bread and butter, 

ten ounces of milk. 

The quality of the bread is extremely important; 

its crust should be crisp and deep, indicating long 

cooking. 

Dinner, 12:30: 

Soup; well-cooked vegetables (green vegetables are 
particularly desirable, as they contain large quan- 
tities of iron) ; meat, either steak, lamb chops, beef 
or chicken; bread and butter. This is a whole- 
some meal. 

Dessert: Custard, stewed prunes, stewed apples, 
baked apple, rice-pudding or plain bread-pudding. 
Ten ounces of milk. Milk may be omitted if 
used in any other form, such as in soup, milk toast 
or cocoa. 

Supper, 6:30: 
Cold meat or fish, eggs in almost any style except 
hard boiled or fried; bread and butter; cooked fruit, 
plain cake, ten ounces of milk. 



SCHOOL CHILDREN 297 

Milk should never be entirely omitted from the diet 
of a school child. Not only is it rich in mineral matters 
used in developing bone, but it contains many nourish- 
ing substances in forms easily assimilated; further- 
more, milk promotes growth in childhood by help- 
ing the body to utilize other foods. 

Since there are so many foods that can not be 
packed, the contents of the lunch-basket become nec- 
essarily limited. Sandwiches, being easily packed, are 
the real foundation of the school lunch, but care must 
be taken to vary them from time to time in order that 
the child's appetite may not become jaded. 

Fruits, such as dates, figs, raisins, or nuts may be 
chopped and added to buttered bread. Lettuce with 
a couple of slices of crisp bacon makes a delicious 
sandwich. A liberal spreading of peanut butter with 
several slices of some tart raw fruit between the slices 
will be enjoyed. Cream cheese may be mixed with 
chopped English walnuts and spread on crackers. 
Honey mixed with cream cheese is especially nice as 
a filling for crisp biscuits. Meat may be chopped and 
moistened with salad dressing. 

Then there is the ever-ready jam and jelly. Brown- 
sugar and maple-sugar sandwiches, as well as other 
simple sweets, should also occasionally find a place 
in the lunch-basket. Sandwiches for the lunch-basket 
should be supplied with a liberal allowance of butter, 
as this is an important source of energy for the active 
child. 



298 THE CARE OF CHILDREN 

The schoolchild's appetite for bread may be stim- 
ulated by changing the bread from day to day. 

Sandwiches should be carefully wrapped in paraffin 
paper. It is better not to wrap more than two to- 
gether. 

Any soft or liquid foods should be carefully packed 
in small jars with screw tops, glasses with tops or in 
paper cups. 

Of course fresh, ripe fruits have an important place 
in the school lunch, not only because they are conven- 
ient to carry, but because they are needed in the diet 
of every child. 

As things eaten raw are likely to transmit germs, 
care should be taken to wash all fruit thoroughly. 

Fruits with skins, such as grapes, peaches, pears or 
plums, are not injured by dipping them into boiling 
water for a few seconds, while bananas, apples and 
oranges may be washed with soap and water. 

Last, but not least, remember that many a good 
lunch is spoiled by careless packing. 



CHAPTER XXXIX 

BRAIN-FAG IN SCHOOL CHILDREN 

Not long ago a mother presented her boy of about 
thirteen years at a busy doctor's office for an examina- 
tion. "Of what does he complain ?" said the physician. 

"He does not complain at all," said the mother. 

"Then of what do you complain?" the doctor smil- 
ingly asked. 

"Doctor," said the mother, "I have brought John 
to see you on what you may call a foolish errand. 
Nevertheless, it is something that has worried me for 
a long time. John, from earliest childhood has always 
had a wonderful disposition, but for the last six 
months I have noticed that he is particularly irritable 
and cross and I have come to the conclusion that he 
must be sick in spite of his insistence that he is all 
right." 

"An acid disposition," mused the physician. Then 
to the mother he said: "Very studious, is he not?" 

"Oh, yes !" she replied, "John is always at his books." 

The doctor studied the boy for a few minutes, then 
turning to the mother said: "You must take him out 
of school for a time; there are unmistakable signs 
of a fagged and overworked brain." 

299 



300 THE CARE OF CHILDREN 

Undoubtedly many children are kept at school who 
ought to be under the care of a physician, because 
parents and teachers have not noticed the symptoms 
indicating a fagged brain, which after all really means 
that the youthful nervous system is being injured. 

Great effort has been directed toward preventive 
medicine, but there is one branch of it which has been 
more or less neglected. We have failed to appreciate 
the fact that all children who come into the schools 
for education are not alike. We have not thoroughly 
realized that countless thousands not only come into 
the world constitutionally inefficient, but they are 
afterward handicapped by environment and training. 

There is no gainsaying the fact that many a break- 
down, either permanent or temporar}/ - , could have been 
averted, had the child been treated a little more indi- 
vidually while in school, and if parents had considered 
the child and his make up before urging him forward. 

A teacher may have a class of thirty pupils; ten 
of these children may be able to accomplish the pre- 
scribed work with ease, but to hold the other twenty 
strictly to the same work may be, and very often is, 
the beginning of serious nervous trouble. 

The insane population of the United States, who 
have been committed to institutions, is estimated at 
two hundred thousand, with as many more outside of 
institutions. A few years ago many of these were 
children enrolled in the schools, and while we can not 
attribute this condition to their school work alone, 



BRAIN-FAG IN SCHOOL CHILDREN 301 

as many of them undoubtedly inherited abnormal ten- 
dencies, it is certainly possible that many could have 
been saved from this sad fate, if they had been treated 
and looked after while they were school children. 

"At least five per cent, of our school children are 
neurotics in the sense that they are more than ordin- 
arily predisposed to the development of mental 'com- 
plexes' unfavorable to the healthy and coordinated 
functioning of intellect, emotions and will," says Mr. 
Lewis M. Terman, Associate Professor of Education, 
Leland Stanford Junior University. 

Some years ago an investigator on this subject sent 
out a set of questionnaires to teachers. Out of one 
hundred and sixteen answers fifty-nine sad cases of 
prostration from overwork among children were re- 
ported. 

It is hard to realize how quickly the mental forces 
of the growing girl and boy become fagged. 

As the child passes from one stage to another, from 
infancy to childhood, and from childhood to adoles- 
cence, the brain, which is really an aggregation of nerve 
centers, is not only growing but new parts are form- 
ing; impressions are constantly received and these ef- 
fect results in building up its structure and organiza- 
tion, but since the child's reserve of energy is small he 
is quickly brought to exhaustion. Furthermore, if 
the demands made upon the nervous system involve 
those parts which are still undeveloped there is danger 
of serious injury to this delicate structure. 



302 THE CARE OF CHILDREN 

For instance, it is possible to force a child to ac- 
complish physical work for which he is unfitted, but 
what is the result? His growth is stunted. So it is 
with the growing and developing nervous system. 

We do not permit our little children to overwork, 
even in play; we instantly recognize and control the 
situation, but when it comes to mental work we rather 
encourage them to go on and on, hardly realizing that 
it can be overdone. 

We must not forget that mental work makes as 
great a demand upon the body organs as physical work 
and that it creates even more fatigue; that when the 
brain has become fagged, important functions of our 
organs, such as the heart and kidneys, are also affected. 

There have been many investigations to prove that 
work done by school children under the strain of on- 
coming fatigue is of hardly any value and that chil- 
dren should not be held to their work after positive 
signs of fatigue have shown themselves. The Rus- 
sian psychiatrist, J. Sikorski, was the first to make an 
endeavor to measure fatigue and its relation to ac- 
curacy in the work of school children. 

The tests employed were considerable amounts of 
work, the pupils writing from dictation for one-quarter 
of an hour early in the day before school work be- 
gan and later in the day after school work was over. 
He found thirty-three per cent, more errors in the 
work done after school was over. 



BRAIN-FAG IN SCHOOL CHILDREN 303 

It should always be borne in mind that what a child 
accomplishes or masters does not depend altogether on 
how long or how hard he works ; it depends more upon 
whether he is working at the maximum of his power 
and whether or not his mental faculties are clogged 
as a result of fatigue. 

Some European countries, notably Switzerland, and 
some states in our own country have realized that time 
is no measure of progress in the schoolroom, and have 
enacted laws against home study for all children below 
the high-school period. The vital question, many edu- 
cators claim, is to teach children how to study, in order 
that energy may not be wasted in misguided efforts. 

"The mind instead of being, as was once supposed, 
like the old-fashioned sensitized plate of photography, 
which required long exposure, is, after all, more like 
the highly sensitized plate of the snap-shot — not long 
exposure but right conditions," says one writer on the 
subject. 

Early in the morning is the best working period and 
ten minutes of concentrated vigorous effort is worth 
ten times ten after the mental faculties have become 
fagged, for mental digestion as well as physical, 
depends largely upon a proper and timely food supply. 

It is thought by many that fatigue brought on by 
long hours of mental work is a real accessory to lateral 
curvature of the spine and other irregularities of pos- 
ture. The muscles controlling posture are held tight 



3 04 THE CARE OF CHILDREN 

by a regular and unconscious outflow of stimulus from 
the nerve centers. 

Now when children become tired they naturally 
assume awkward positions because it requires nervous 
energy to sit erect. 

Mental work for young children should be in short 
periods and should alternate with short periods of 
rest; they should be allowed much freedom of move- 
ment, and home study should not be required of them. 
When out of school they should be urged to muscular 
activity in the open air, for not only is play one of 
the most potent means of reducing the fatigue of the 
school-room to a minimum but it has other missions. 

Children are very prone to anaemia and their resist- 
ance to disease is inferior ; muscular activity stimulates 
the flow of lymph and the circulation of the blood and 
as this plays a large part in a child's nutrition and re- 
sistance to disease, it can readily be seen that seden- 
tary habits are particularly injurious. 

One of the first signs of mental fatigue in children 
is inattention and lack of power to concentrate. Now 
why is this? 

Because it is a law of Nature to accumulate a re- 
serve of energy, both mental and physical, which sur- 
plus is not drawn upon except under great provoca- 
tion and at times of unusual stress. 

Inattention has been designed by Nature as a sort 
of safety valve that these deeper levels of energy may 
be protected; in other words, that they may not be 



BRAIN-FAG IN SCHOOL CHILDREN 305 

drawn upon too completely ; inattention has, therefore, 
a positive function ; it is a warning that the child needs 
recreation in order that the poisons produced by fa- 
tigue may be expelled from the blood. 

There are a series of signs and symptoms of brain- 
fag occurring among school children of all ages ; these 
are sometimes slight, sometimes quite outspoken, but 
parents and teachers often fail to interpret their sig- 
nificance. 

Some of these symptoms as mentioned by physicians 
are: 

A restless wandering of the eyes, compression of the 
lips, protruding of the tongue with each new effort, 
extreme irritability, indigestion, general tired feeling, 
stumbling over words when speaking, substitution of 
one word for another, or extreme forget fulness; that 
is, you may tell the child to bring you an article from 
the next room, but before he is able to do so, he has 
forgotten what it is you told him. 

These symptoms are very mild, but others more pro- 
nounced may show themselves, such as : 

Involuntary muscular twitchings of the hands, face 
or eyes, frowns or grimaces unconsciously made, asym- 
metry of posture, unequal movements of the two sides 
of the body; the arms when extended may not be on 
the same level. 

Mistakes in writing or bad or shaky handwriting 
may not always be due to poor scholarship ; they may 
be due to nerve fatigue. Sleepiness, headache, and loss 



306 THE CARE OF CHILDREN 

of memory among students are unmistakable signs of 
mental fatigue. 

The danger from brain-fag is especially significant 
in the upper grammar-school grades and in the early 
high-school period, when one is passing from child- 
hood into adolescence and when the intellectual and 
emotional life are somewhat loosely joined. 

Most emphatically does this apply to the adolescent 
girl. We see her so often. She was perfectly well 
up to thirteen or fourteen. But now she is pale and 
languid, often irritable and usually in a feverish state 
of excitement ; we note her nervous laughter, her short- 
ness of breath after exertion and her asymmetry of 
posture; we note her constant complaint of indiges- 
tion, headache, and tired feeling. She is just entering 
high school, an increased mental demand is made upon 
her and much nervous energy is wasted worrying over 
examinations at stated periods, also her interest in 
social life is just beginning to be stimulated. 

All these demands for nervous energy together with 
the added requirements of growth are very apt to be 
more than the organism can supply, particularly if the 
girl is not unusually robust and strong. 

Parents and teachers should be extremely careful 
to keep in mind the tendency to anaemia and nervous 
affections during the state of adolescence, and also that 
many nervous and mental breakdowns occur among 
both girls and boys during this period. 

When languor presents itself, mental work should 



BRAIN-FAG IN SCHOOL CHILDREN 307 

cease, for all effort after this is a strain upon the 
nerves. The aim should always be to have a surplus of 
nervous energy, what Emerson calls "plus health." 

While the amount of mental work the student can 
do is a matter of individuality, when danger-signals 
present themselves, even in a moderate degree, they 
should not be disregarded, but the hours of work 
should be shortened. 

Those who are inclined to be nervous should be as 
free as possible from excitement and irregularity; 
should have plenty of nutritious food, much exercise in 
the open air and an abundance of sleep. 

While eight hours of sleep is considered the mini- 
mum for the maintenance of health under ordinary 
conditions, this amount is not sufficient for the young 
brain-worker. 

Mental work should not be required on Saturday 
and Sunday, but a large part of this time should be 
used for diversion and recreation in order that the 
fatigue products accumulated during the week may be 
expelled from the system and that the overworked 
nerve cells in the brain may have time to recuperate. 

"All work and no play makes Jack a dull boy," has 
become a trite saying, but after all it is a real physio- 
logical dictum. For while that force generated in the 
human brain is the most precious in the world, to waste 
it or cause others to do so is to sin against all for 
which human energy and vigor stand, for "knowledge 
without health can not profit us." 



CHAPTER XE 

CULTIVATING THE SPEAKING VOICE 

All of us have at some time been delighted and 
charmed by a beautiful speaking voice; all of us have 
more often been repelled by a harsh mechanical voice. 
How often one fails to make the desired impression, 
succeeding only in tiring the listener because of in- 
distinct articulation or fatiguing resonance of the 
voice. 

The influence of the speaking voice in all the rela- 
tions of life, business, social or domestic, cannot be 
estimated. It may have a calming or irritating in- 
fluence. And in our daily concourse the ability to 
deliver words clearly in a pleasing voice, inspires to- 
ward us not only a better understanding from others, 
but a better feeling. That a good voice is an economic 
asset business men thoroughly appreciate, many of 
them refusing today to employ those suffering from 
any defect of speech. 

That the voice should be cultivated collaterally with 
the culture of words, the spoken word and vocal tone 
growing up together, even from the standpoint of 
health, is no longer doubted. For not only may a 
voice have a good or bad reflex action upon its posses- 

308 



CULTIVATING SPEAKING VOICE 309 

sor, but by the true use of voice, tuberculosis in 
many with the tendency could be successfully warded 
off. 

It is plain that childhood is the time when the foun- 
dation is laid for the acquisition of correct speech and 
a pleasing speaking voice. Even a baby will listen 
intently and turn instantly at the sound of an unusual 
voice. 

The Hawaiian children learn to sing as readily 
as they learn to talk merely by listening to their 
parents singing all day at their work. Parents may, 
by means of a little care and the application of a few 
principles do more and with far better results than it 
is possible for a teacher to accomplish at a later 
date. 

The great aim should be not to allow the high pitched 
tone, nasal twang, whine or other imperfections to fix 
themselves in childhood. For their growth is so 
subtle and so deep, the work of correction in later life 
is apt to be slow and arduous. Many defects and 
anomalies are acquired chiefly by imitation. In lisp- 
ing the influence of imitation is generally admitted 
to be very important. Recently a physician reported 
having observed this speech defect in five children in 
one family. It had been acquired from a lisping 
maid. The unconscious observation of a child is very 
keen, so if those who surround him have linguistic de- 
fects, he may develop similar ones. In a very young 
child a defect of speech may appear to be attractive, 



310 THE CARE OF CHILDREN 

but if allowed to go on, it can be overcome only with 
great difficulty if at all. And now where is the begin- 
ing? 

First, the parents must establish an ideal. That is, 
they must know what constitutes a beautiful mode of 
speaking; they must learn to distinguish good sounds 
in speech from bad sounds and accustom their chil- 
dren to hearing good speaking voices. Close atten- 
tion to the language of others who speak better than 
we will help immensely in cultivating the ear to the 
appreciation of vocal charm. By studying the voice 
that pleases and endeavoring to imitate it much may 
be accomplished, since the imitative power of the vo- 
cal cords is unlimited. While at first, when trying to 
acquire a quality that pleases, a conscious effort is 
required, this soon falls into the realm of the uncon- 
scious. In other words, what was at first a conscious 
effort soon becomes a habit. In what does a beautiful 
mode of speaking consist? 

The quality which we would place at the top is mod- 
ulation — a voice always under control, one so disci- 
plined as never to be irritating to the nerves or to the 
ear of good taste. With this there should be a nat- 
ural, easy utterance, clear and distinct, carrying a full 
and vital expression, and having rather than a wide 
range of sound, beauty of tone. These are the essen- 
tial qualities that make for good speaking. While they 
cannot all be acquired at once, parents should have 
them fixed in mind as a goal to be reached by their 



CULTIVATING SPEAKING VOICE 311 

children. And now having established an ideal of good 
speech, how shall we begin to work toward it? 

There are three physical essentials for the cultiva- 
tion of a pleasing speaking voice : — 

Good teeth 

A non-constricted, clear and open throat 

Nasal cavities free from obstruction. 

The child's teeth should always have the best of care, 
for by their neglect and subsequent deformity, the 
utterance may be spoiled. 

The muscles of the throat should be allowed free- 
dom of action, that is, they should not be constricted 
by high or tight collars, and there should be no ob- 
struction such as excessively enlarged tonsils would 
cause. 

In perfect speech the principal sounds issue from 
the mouth, but they must be strengthened by the res- 
onance of the nasal cavities. This resonance cannot 
be properly given, if in the nasal passages there is 
any interference such as adenoid growths or spurs 
of bone. Always, too, the general health must be 
taken into consideration. For whatever pertains to 
physical health immediately affects the voice. With the 
bodily health at low ebb it is simply impossible to have 
a clear and sustained tone. This is also true where the 
posture is poor and the breathing incorrect. 

And now as to fundamental training. 

First, we believe that parents should recognize and 
endeavor to eradicate in early life the nasal tendency, 



3 i2 THE CARE OF CHILDREN 

the tendency to whine or the tone pitched too high just 
as quickly as they correct faulty pronunciation or 
grammatical construction. For it should be remem- 
bered always that the habits of speech which the child 
is acquiring will be the vocal habits of the adult. 

In a general way, the study of voice culture is di- 
vided into two parts — correct breathing, articulation 
and pronunciation. If given half a chance, that is, if 
the child is taught to stand and sit erect, nature will 
attend to the breath supply so far as ordinary speak- 
ing is concerned. If, however, the child's voice is thin, 
feeble or shrill, it means incorrect breathing. To 
correct this, teach the child to breathe deeply, that is, 
to breathe from the diaphragm (the muscle between the 
chest and abdomen). This means breathing from the 
bottom of the chest instead of from the top. While 
one breathes without being consciously aware of it, the 
art of deep breathing has to be acquired by practice. 
When practising deep breathing have the child stand 
in a well poised position. 

The feet should be slightly apart, toes pointing 
straight ahead, weight equally distributed between the 
feet. The hips should be straight, stomach drawn in 
(not evidencing effort) but showing the result of 
correct hip and chest posture. The chest should be 
held high with the chin lifted but not tilted. The 
shoulders should be dropped downwards, not forced 
back, as they will be back if the chest is high. In 
this position tell the child to fill the lungs (to inhale) 



CULTIVATING SPEAKING VOICE 313 

and to try before expiration to make a slow mental 
count of five, exhaling sometimes explosively and some- 
times slowly and steadily. If this is done regularly 
for a few minutes each day, little by little the lungs 
will dilate and one will unconsciously increase the 
length of the inspirations and the slowness with which 
the air is expelled, until gradually the count may be in- 
creased to ten or fifteen. While as we have said, 
breathing may be thoroughly unconscious in ordinary 
speaking, there are some qualities, not the least of 
which is resonance (that quality which sustains tone) 
that cannot be acquired without proper breath control. 
To be assured that resonance and carrying power are 
accomplished by control of respiration, one need only 
notice the singer who has developed vocal ability or the 
actress who has attained mastery of speech. What do 
they do? 

They breathe deeply, thus securing the proper voice 
support. 

It is by means of the articulating muscles that the 
organs of speech change their relative positions and 
assume the attitudes necessary for the formation of 
the vowel and consonant sounds. And in training for 
a correct speaking voice these muscles must be brought 
into play and one must learn to form consciously and 
correctly the many vowel and consonant sounds. The 
vowel sounds are the most difficult because they are 
what may be called open-mouth sounds. They must 
be made with an open throat, mouth, teeth and lips. 



3 i4 THE CARE OF CHILDREN 

For vowel sounds, see page 241, "The Child's Speech/' 
Repeat the scale down and up until you are conscious 
of the changes in adjustment of the speech organs and 
try to associate each sound with its position. Prac- 
tice this scale slowly at first, then increase the speed, 
keeping each sound separate and distinct. Go over 
it frequently until the correct habit of producing 
each sound is fixed. Care should be taken that the 
sounds are not nasal and no great muscular effort 
should be made. This effort is one of the major causes 
of throat contraction and "throaty voice." The child 
should also be drilled in repeating aloud the alphabet, 
making sure that every letter is pronounced not only 
distinctly but is given the correct sound. For in- 
stance, that the letter h is never pronounced as though 
it were aitch and the letter w not as "double yer." In 
going over the alphabet see that the child brings out 
every letter vigorously and concisely. Do not allow 
him to drawl the letters. Remember that the drawl 
is not only very apt to result in the habit of whining, 
but that concise and spirited expression has a stimulat- 
ing effect upon the mind. In other words, it marks 
for the child a step toward health. 

In meeting the difficulty of pronouncing a difficult 
word do not allow the child to try to say it all in one 
breath, thus getting the syllables mixed. Teach him to 
pronounce it syllable after syllable, pausing after each 
effort and then going quietly on. 

Smooth, rippling, happy poems, repeated in the right 



CULTIVATING SPEAKING VOICE 315 

tone, either from memory or as reading exercises, will 
not only aid in acquiring effective modulation but 
will help to beautify the notes. 

The faculty of taking pains and a little practice 
with the child every day will work wonders toward 
acquring a beautiful speaking voice which will soon be- 
come a habit. Let us not hesitate to take these pains, 
remembering always that we cannot, like a dress to 
be put on in the evening, have two kinds of speech, 
but that the child's every-day habits will mark the 
adult's speech habits and that beautiful speech is a 
mark of true culture. 



CHAPTER XLI 

SICKNESS IN THE FAMILY SMALL 

BUT INVALUABLE HELPS 

Every mother should understand how to prepare 
and apply such applications as a physican may order 
for home treatment. She should also know something 
of the effect they are supposed to produce. For even 
with the simplest remedy, unless properly carried out, 
much of its effect is lost. 

Not long ago I met a mother who with her child had 
come some distance to consult a physician. The doc- 
tor after an examination advised the mother to take 
the child home and apply hot fomentations. 

It was clear from the expression on this mother's 
face, that she had only a vague idea of how to carry 
out the instruction. "Do you understand how to apply 
the hot applications?" I asked. 

"Not exactly," she answered, "but I have a neighbor 
who seems to understand such things, perhaps I can 
find out from her." 

Hot fomentations and hot poultices are usually or- 
dered for localized or deep-seated pain, when the pain 
is caused by inflammation. The heat by dilating the 

superficial blood vessels draws the blood from the con- 

316 






SICKNESS IN THE FAMILY 317 

gested area, relieves the pain and promotes suppura- 
tion. 

For Hot Fomentations: The most effectual way is 
to have two compresses of the required size and apply 
them alternately. Squares cut from an old bath towel 
are excellent for this purpose since this material seems 
to hold heat even longer than flannel. The water 
should be not just hot but boiling. Place the compress 
in the center of a towel and dip into the boiling water. 
Wring by twisting the ends of the towel. Now give 
the compress a quick shake and apply over the affected 
area, covering at once with oil muslin or oil paper. 
If possible wrap a bandage or a towel around the part 
to aid in keeping in the heat. Hot fomentations are 
usually changed at least every twenty minutes. 

For a Poultice: Any non-irritating substance, capa- 
ble of holding and conveying moist heat, is effica- 
cious. 

The flax seed (linseed) poultice, since it combines 
these two qualities is the one most generally used. 

To Make a Flax Seed Poultice: Stir the meal 
slowly and evenly into water while it is boiling. 
When almost thick enough, boil about a minute longer, 
stirring constantly. Now remove the mixture to a 
low flame and beat thoroughly. This beating is done 
for two purposes. To remove all lumps and incorpo- 
rate into it a certain amount of air. When properly 
made, the poultice should be perfectiy smooth and of 



3 i8 THE CARE OF CHILDREN 

a consistency just stiff enough to drop away from the 
spoon. It should now be spread about one-half inch 
thick on a piece of muslin of the required size and 
shape. This material should be large enough to fold 
over the poultice once, allowing for a margin to be 
turned in all around of at least one-half inch. On the 
side to go next the skin, apply vaseline. And over 
this put a thin layer of cheese cloth or gauze cut large 
enough to turn back over the top. The poultice is 
now ready to be applied. It should be carried to the 
bedside on a hot plate covered with a towel and should 
be as hot as can be borne but not hot enough to burn. 
When in place cover the poultice with a layer of cotton 
and to prevent the escape of heat and moisture apply 
a piece of oil silk. If oil silk is not at hand, lay over 
it a piece of hot flannel Hold all in place by pinning 
around the part a bandage or towel. 

A poultice should always be removed before it has 
become cold but the fresh one should be ready to apply 
before the old one is removed. Before making the 
fresh application the skin should be wiped dry. Do 
not attempt to reheat and apply a poultice which has 
once been used. It will serve no purpose. 

To Make a Starch Poultice: Sometimes when there 
is skin irritation, on account of its soothing properties, 
a starch poultice is ordered. To make this: 

Mix the starch first with a little cold water, then add 
boiling water until it becomes the consistency of thick 
paste. Now spread on muslin covering only with a 



SICKNESS IN THE FAMILY 319 

layer of thin gauze. In this way the starch is allowed 
to come in direct contact with the skin. 

Cold Applications: When conditions are such as to 
contra-indicate hot applications, cold is applied. This 
is usually done by means of an ice cap or by cold 
compresses. When properly filled, an ice cap should be 
free from air, light and dry. The ice should be broken 
into fine pieces, filling the cap not more than one-half 
full. Before screwing on the top, in order to expel the 
air, place on a flat surface. Now wipe dry and to 
prevent the rubber and the extreme cold from coming 
next to the skin, tie around the cap an old handker- 
chief or a piece of gauze. 

The weight of an ice cap as an objectionable feature 
can be entirely eliminated by tying around its neck a 
bandage and pinning the two ends high enough on the 
pillow to barely allow the cap to touch the head. 

For Cold Compresses: Put a small piece of ice in 
a basin, adding a little water. Fold two old handker- 
chiefs or soft gauze two or three thicknesses, making 
them narrow enough not to wet the hair or come down 
over the eyes. If gauze is used, avoid ravelings by 
turning in the ends. While one compress is being 
used the other should be kept on ice. Compresses 
should not be made wet enough to drip. To prevent 
irritation a little vaseline may be rubbed on the skin. 

If for the eyes, the compress should be small and 
very light. If only one eye is affected, be careful not 
to infect the other by contact. 



320 THE CARE OF CHILDREN 

Mustard Plasters: It is by virtue of the irritating 
effect of the mustard on the sensory nerves that a 
mustard plaster relieves pain. The superficial blood 
vessels under the point of application are dilated, thus 
causing a lessening of congestion. 

For young children a mustard paste is usually or- 
dered in strength of one to six, or one to eight. This 
means one part powdered mustard and six or eight 
parts of flour. Use tepid water and make into a paste 
free from lumps. Hot water since it has a tendency 
to lessen the strength of the volatile substance which 
gives mustard its irritating qualities should not be used 
in the mixing. 

The paste should be spread on old linen of the re- 
quired size, allowing enough material to turn over once 
and a margin for turning in the edges. The plaster 
should now be placed on a hot plate and carried to the 
bedside. Before applying, the surface of the skin 
should be well greased with vaseline. When in place 
cover with a layer of cotton. With children the skin 
is usually sufficiently red after an application of a few 
minutes. Always watch carefully for if left on too 
long the skin will blister. For adults the paste is 
made much stronger and left on longer, usually from 
ten to twenty minutes. 

After the mustard plaster has been removed wash 
the skin carefully and reapply a little vaseline. In case 
of over-irritation, apply a layer of cotton so as to ex- 
clude the air. 



SICKNESS IN THE FAMILY 321 

Mustard Foot-Bath: The object of a hot mustard 
foot-bath is to dilate the blood vessels of the extrem- 
ities, bring more blood to the parts and thus equalize 
the circulation. To properly give this: — 

Put the child to bed. Half fill a small foot-tub with 
water at a temperature of 115 degrees. The mustard 
should be in the proportion of an even teaspoon ful 
to each quart of water. Before adding to the water 
it should either be tied in gauze or made into a paste. 
After protecting the bed by a mackintosh (covered 
with a towel), place the foot-tub on the bed and by 
bending the limbs at the knees allow the child's feet 
to rest in the water. The duration of the bath should 
be fifteen minutes. During this time by the addition 
of hot water from time to time maintain the tempera- 
ture at 115 degrees or more. Always use extreme 
care, when adding water, not to allow it to come in 
contact with the child's extremities. Throughout the 
bath the knees and the foot-tub should be kept covered 
with a blanket. At the end of the required time 
gently wipe the feet and tuck the child warmly 
into bed. 

How to Give An Enema: For a simple enema to 
relieve constipation make a suds of warm water and 
castile soap, pouring one pint of this solution into the 
bag of a fountain syringe. Then while sitting on a 
low chair, place over the lap a rubber sheet (covered 
with a large bath towel) letting this form a trough 
into a foot tub. Take the baby on the lap, allowing 



322 THE CARE OF CHILDREN 

him to lie upon the left side with the legs well drawn 
up. Now oil the black rubber tip of the syringe and with 
the right hand introduce it gently into the anus. Then 
while holding the tube with the left hand, allow the 
solution to flow in slowly. The bag of the syringe 
should hang about two feet above the baby's head. 
After the tip of the syringe has been removed, in 
order that the baby may retain the enema for a few 
minutes, apply pressure at the anus with a folded 
towel. 

Bowel Irrigation: A bowel irrigation is frequently 
given during an attack of diarrhoea, especially if the 
stools contain blood or mucus. In giving an irrigation 
the baby should be held in the same position as for 
an enema, but in place of the hard rubber nozzle, a 
soft rubber English catheter (size about 14) should be 
used. This is attached to the fountain syringe by 
means of a glass connecting tube. The tip of the 
catheter which has been well oiled should be held in 
the right hand and inserted as gently as possible up- 
ward and slightly backward, (following the natural 
curve of the rectum) a distance of two and a half to 
three inches. Hold the tube in place with the left 
hand and with the bag elevated from two to three feet 
above the head of the baby, allow the water to flow in 
slowly. If any resistance is felt the tube should be 
removed. Never force the tube in giving either an 
enema or an irrigation. 



SICKNESS IN THE FAMILY 3^3 

Attention to the little things that may seem unim- 
portant, not only add to the comfort of the one re- 
ceiving the treatment, but, more important, they have 
a great effect upon the ultimate result. 



CHAPTER XLII 

PALATE TICKLERS FOR THE LITTLE SICK-A-BED 

Nowhere is the truth of Solomon's assertion "a 
merry heart doeth good like a medicine" more clearly 
vindicated than in bringing back to the borderland 
of health the lagging appetite of the little convales- 
cent. In seeking to stimulate the appetite of a child it 
is not so much the food we put before him as the 
appeal we make to his imagination. 

Said an ingenious nurse to a little Pale Face whom 
she had been unsuccessfully coaxing to eat: "Next 
time I will bring some animals to help you eat the 
food." The little child smiled wanly. But he was 
interested as shown by a later question : 

"Where are you going to get the animals who will 
help me eat?" 

"Oh ! I will telephone the Zoo," said the nurse. 

When at last the napkin was lifted from the tray 
there was a cry of delight. For there in each corner 
of the tray was a circus sandwich — the elephant, the 
camel, the lion and monkey — all standing guard over 
the food. "Now," began the nurse, "they are all 
hungry animals, for none of them have had dinner." 
Then she began to tell of some of their circus feats, 

324 



PALATE TICKLERS 325 

of how they lived and what they ate. The effect was 
all she had hoped. For at last came the cry : "I did 
not leave any for the big elephant, he will have to wait 
until next time." 

To Make the Circus Sandwiches: Cut tiny squares 
of brown bread. Put them together with a filling of 
chopped dates and cream. Then on top of each sand- 
wich put a little frosting, affixing to this before it 
has hardened, an animal cracker in the upright posi- 
tion. 

The goblin sandwich will also prove interesting. 
Slice bread quite thin and trim so the slices will be 
much longer than they are wide. Spread with butter 
and jelly, then roll like a jelly- roll cake. Now take 
a large round, red radish and after cutting a mouth and 
two eyes,. fasten by means of a tooth pick, to one end 
of the roll. For a tail add to the other end of the 
sandwich a long narrow radish. Then on either side 
place two tooth picks to represent legs. 

The wish sandwich will also prove diverting. Cut 
brown bread into the shape of a horse-shoe and after 
some filling has been applied, place it — filling side 
down — on a piece of white buttered bread. With this 
the child may make a wish as he takes the first bite. 

Liquids may be served from a bottle concealed by 
a long flowing robe of tissue paper, using for the 
stopper a paper-doll head. Thus may the child have 
"Miss Dolly Madison" as a dinner guest. He might 
also receive a note to this effect. 



326 THE CARE OF CHILDREN 

Sometimes children tire so of milk, difficulty is ex- 
perienced in persuading them to take it. Milk can be 
quite successfully disguised by adding a teaspoon ful 
of cocoa paste and calling it liquid ice cream. 

The cereal of which the child has grown tired will 
take on a new interest if served in a glass dish at the 
bottom of which is a big red or green marble. The 
color of the marble will reflect on the under surface 
of the dish. This will excite the child's curiosity 
which cannot be satisfied until he has disposed of the 
contents of the bowl. Cereal may be somewhat dis- 
guised by stirring in a few soft cooked prunes or 
dates. 

Even the commonplace crackers, will take on a 
jaunty party air if tied in pairs with different bright 
colored ribbons and piled in a rainbow heap, allowing 
the child to choose his color. 

A dainty basket may be fashioned from an orange. 
Cut away one quarter of the orange on either side, 
leaving a strip for the handle. By means of a pair 
of scissors notch the margin of the basket and both 
sides of the handle and tie the handle with a pretty 
ribbon. The meat from the sections taken from the 
sides can be piled on the basket after it has been com- 
pleted. 

By keeping the basket in cold water it may be used 
several times. It is quite effective when filled with 
strawberries, orange jelly or other dainties. 

Then the orange may be served as plain Black Eyed 



PALATE TICKLERS 327 

Susan. For this: Pull from the orange both the 
yellow and white rinds and with a sharp knife cut be- 
tween the sections. On a white dish arrange the sec- 
tions in wheel-spoke fashion, leaving an open space 
in the center. Fill in the open space with a prune or 
two, cooked until tender and chopped into small pieces. 

The egg with which the child has grown too famil- 
iar, may, if his imagination is awakened, again be 
relished. 

First, there is the Bird's Nest. To make this: — 

Cut a slice of bread a little thicker than for ordinary 
toast. After it has been toasted cut from its center a 
good sized square, leaving at the bottom just a thin 
layer of crust. Separate an egg and after beating 
stiff the white, drop it into the hollow place made in 
the toast, afterwards slipping into the center of the 
white the unbroken yolk. Place in the oven until the 
white of the egg is nicely browned. 

Then, the poached egg after it has been placed on the 
toast may be surrounded by a log cabin, made by pil- 
ing up sticks of toast, one on the other, four square. 

The egg to be soft boiled may, before it is dropped 
into the water, have a grotesque face sketched on by 
means of a soft pencil. Thus may Humpty Dumpty 
make his appearance. 

Sometimes a fascinating name given to a familiar 
dish, will arouse the child's imagination and make the 
food most welcome. 

Among these are : — 



328 THE CARE OF CHILDREN 

Little Pigs in Blankets, Tom Thumb and Blind 
Billy. 

For Little Pigs in Blankets: Select a few large 
plump oysters and wash each one so as to avoid any 
little pieces of shell. By means of a tooth-pick 
skewer around each oyster a thin slice of bacon. 
Crisp in a hot oven and serve on rounds of toast. 

For Tom Thumb: Break an tgg into a buttered 
dish, stir in two tablespoon fuls of milk, and season 
well with salt, pepper and chopped parsley. Cover 
this with grated cheese and bread crumbs. Place 
little dots of butter here and there over the top and 
bake in a quick oven until the egg is well set. 

For Blind Billy: Remove from a turkey or other 
large fowl the drum stick. Let this simmer slowly until 
the bone can be easily withdrawn. After tying the 
smaller end securely with heavy thread, stuff the cavity 
with some well seasoned vegetable and hold the other 
end together by means of tooth-picks. Around this 
now roll a slice of bacon, place on a square of toast 
and allow it to broil in the oven for a few minutes. 

The number of fascinating ways in which desserts 
may be fixed are legion. 

Gelatin may be served in a boat shaped from the 
skin of a banana and lined with white paper, using 
tooth-picks for oars. 

Then there is the Log Cabin Snow Drift. For 
this : — 



PALATE TICKLERS 329 

Cut cake into narrow strips, four or five inches 
long. Pile these one on the other four square, filling 
the center either with white of egg beaten stiff and 
sweetened or with whipped cream. 

Blanc-mange or junket may be served in colored 
egg-shells. Save the shells intact by pouring the egg 
out through a hole made in the small end. Fill the 
shells with cold water and color by means of colored 
pencils. While the blanc-mange or junket is still 
warm pour into the shells. After it has cooled and 
hardened the child may be allowed to peel off the shell, 
revealing the dessert in the shape of an cgg f or he 
may eat it from the shell. 



CHAPTER XLIII 

PLAY FOR LITTLE INVALIDS 

Every mother and nurse who has had the care of 
a child during the trying period of convalescence knows 
that the time is sure to come when he will want some- 
thing new. 

First among the things which hold a child's interest 
is story-telling. A tale well told will hold his atten- 
tion much better than if read from a book, as the 
telling makes it more real to him. He can be inter- 
ested for a long time by making up a story in which 
he has to take part. As a beginning, let him guess the 
name of all the animals he can think of whose names 
begin with "A," then "B," and so on. Then tell 
him a story about some of those animals. The story 
can be very simple, and yet in connection with the 
guessing will interest the child. 

If one can contrive to keep a child busy and inter- 
ested without allowing him to become overtired, then 
the battle is won. That means always that new things 
must be brought forward when the old ones begin to 
pall. 

Stringing beads and making them into chains and 
bracelets will always amuse him for a while. 

330 



PLAY FOR LITTLE INVALIDS 331 

I know a child who spent several happy days play- 
ing with colored modeling wax. He rolled it out 
with a small rolling-pin, stuck toothpicks along for 
trolley-poles and strung them with heavy cotton. A 
bed-roller was his trolley-car and a toothpick held in 
place by a little of the wax was his trolley-pole. 

Many children will find delight in handling differ- 
ent-colored papers and combining the colors; also in 
pasting pictures and post-cards into a scrap-book. 
A scrap-book can easily be made by folding old win- 
dow-shades and sewing them into booklets. 

Seed catalogs and magazines with pictures of flow- 
ers can also be used. Have the child cut these out 
neatly and paste them in a circle on a piece of heavy 
paper, thus making a wreath with which the wall 
may be decorated. 

Uncolored pictures found in magazines and a box 
of crayons will while away the time pleasantly. 

From the colored covers of magazines picture puz- 
zles may be made. After mounting these on card- 
board, cut them into irregular pieces, which the child 
can reconstruct. The smaller the child the larger the 
pieces of the puzzles should be cut. 

Simple map-tracing, by means of thin paper and the 
transparent slate, with its simple pictures will also 
find its place. 

A little girl domestically inclined may play house- 
keeping. Supply her with a cardboard box and a 
furniture catalog. The lid of the box may be used for 



332 THE CARE OF CHILDREN 

partitioning the rooms. Then after cutting out the 
furniture she can place it in the different rooms. By- 
making slits in the box the furniture may be inserted 
so it will stand upright. 

Folding a paper several times, cutting a figure to 
resemble a man, thus making row after row of soldiers, 
is always a source of unfailing interest to a boy. 

If the child is well enough, blowing soap-bubbles is 
always a joy. 

Beautiful colors made by hanging a string of glass 
prisms in a sunny window are a source of delight. 

If it is not too much excitement for him, a little 
boy will have great fun shooting tin soldiers from the 
foot of his bed with a harmless pop-gun. 

A performing circus will amuse him immensely. 
Draw or trace on a sheet of thin paper some pictures 
of birds and butterflies. Have the child color their 
wings with colored pencils and cut each one out sep- 
arately. Then from some illustrated magazine cut 
pictures of animals and place these with the birds and 
butterflies on a flat, dry surface. Now hold a rather 
heavy piece of wrapping-paper before the fire until it 
is quite hot (care being taken not to scorch), after 
which rub it several times in the same direction over 
a woolen sleeve. 

Quickly transfer this paper to the waiting menagerie, 
holding it flat over the pictures, meantime gently rais- 
ing and lowering it. Some of the animals will curl 
Mp and tumble over on their sides or stand on their 



PLAY FOR LITTLE INVALIDS 333 

heads, while the little birds and butterflies will fly up 
and down, often perching themselves on top of the 
magic paper. When the animals tire of performing, 
reheat the paper. 

Another interesting game can be arranged by secur- 
ing from the drug-store some hollow straws, such as 
are used with soft drinks. After cutting them into 
odd short lengths, pile them on the back of a book 
and cover with a small flag. Then by placing a hat- 
pin in one end, remove the straws one by one. Each 
player has a turn, but if the flag falls off the book his 
turn is ended. The one having the largest number of 
straws wins. 

Imaginary "Hide-and-Seek" will also be enjoyed. 
Close your eyes and tell the child to make-believe-hide 
somewhere in the room. Then you begin to guess: 
"In the closet?" "No; you are cold." "Behind the 
door?" "No; still cold"; and thus you guess until 
you strike it right. 

Never allow a child to play until he becomes tired 
or over-excited. Always see that he is fixed com- 
fortably in bed before arranging any amusement. 
[When sitting up in bed see that his back is well sup- 
ported by pillows and that a soft pillow is tucked under 
the knees. This will relieve the tension of the leg 
muscles. If the regular invalid's table is not at hand, 
a sewing lap-board held in place by books makes a 
good substitute. 



BIBLIOGRAPHY 

Slemons, J. Morris. The Prospective Mother. D. 
Appleton and Company, New York. 

West, Mrs. Max. Prenatal Care. Care of Chil- 
dren, Series No. 2. Bureau Publication No. 4, U. S. 
Department of Labor, Children's Bureau. 

West, Mrs. Max. Infant Care. Care of Children, 
Series No. 2, Children's Bureau, U. S. Department 
of Labor. 

West, Mrs. Max. Child Care, Part 1, "The Pre- 
school Age," Care of Children, Series No. 3, U. S. 
Department of Labor. 

Kerley, Charles G. Short Talks with Young 
Mothers. G. P. Putnam's Sons, New York. 

Kerley, Charles G. The Practice of Pediatrics, 
W. B. Saunders Company, Philadelphia, Pa. 

Chapin, H. D. & Pisek, G. R. Diseases of Infants 
and Children, William Wood and Company, New 
York City, 1919. 

Rucker, W. C, Asst. Surgeon General and Pierce, 
C. C, Surgeon, U. S. Public Health Service. Sup- 
plement No. 16 to Public Health Reports, edition of 
1916. 

Rucker, W. C, Asst. Surgeon General United 
States Public Health Service. Whooping Cough: 

334 



BIBLIOGRAPHY 335 

Its Nature and Prevention, — Edition of June 19 16, 
Reprint from Public Health Reports No. 100. 

McCollum, E. V. The American Home Diet, 
Frederick C. Mathews Company, Detroit, Michigan. 

Courtney, Angelia M., Fales, Helen L., & Bartlett, 
Frederick H., M. D., New York. "Some Analyses of 
Vegetables Showing the Effect of the Method of 
Cooking." American Journal of Diseases of Chil- 
dren, July 19 17, pp. 34 to 40. 

Fones, A. C. "Mouth Hygiene for School Chil- 
dren." Modern Medicine, Feb. 1922, pp. 119-222. 

Hays, Harold M. "Needed Measures for the Pre- 
vention of Deafness During Early Life." Journal of 
the American Medical Association, July 23, 192 1. 

Whitman, Royal. A Treatise on Orthopcedic Sur- 
gery. Lea and Febiger, New York, 19 10. 

Nutt, John Joseph. Disease and Deformities of the 
Foot. E. B. Treat & Co. New York, 1913. 

Scholl, William M. The Human Foot; Anatomy, 
Deformities and Treatment. Foot Spec. Pub. Com- 
pany, Chicago, 1920. 

Carhart, William Merle. Refractive Errors Caus- 
ing Retardation in School. Reprint Series 63, Dept. 
of Health, City of New York. Sight Conservation 
Work of The Department of Health Among School 
Children, Bulletin No. 26, New Series Vol. X. De- 
partment of Health, City of New York. 

Barker, Lewellys F. Principles of Mental Hygiene 
applied to the Management of Children Predisposed to 



336 BIBLIOGRAPHY 

Nervousness, The National Committee for Mental 
Hygiene, 50 Union Square, New York. 

Campbell, C. Macfie. Nervous Children and Their 
Training. Johns Hopkins Hospital, Baltimore, Mary- 
land. The National Committee for Mental Hygiene, 
50 Union Square, New York. 

Burnham, William H., President Mass. Society for 
Mental Hygiene, Mental Health for Normal Chil- 
dren. 

Williams, Tom A. "The Medical Treatment of Ex- 
ceptional Children," New York Medical Journal, Jan- 
uary 8, 19 1 6. 

Martin, Frederick. The Prevention and Correction 
of Speech Defects. Bulletin No. II, Board of Educa- 
tion Section, City of New York. 

Martin, Frederick. Stammering. Keep Well Leaf- 
let No. 18, Bureau of Public Health Education of the 
Department of Health, City of New York. 

Goldthwait, Joel E. "The Relation of Posture to 
Human Efficiency and the Influence of Poise upon 
the Support and Functions of the Viscera." Boston 
Medical and Surgical Journal, December 9th, 1909. 

Dickson, Frank D. "Effect of Posture on the 
Health of ithe Child." Journal of the American Med- 
ical Association, Vol. Jj, No. 10, p. 760, September 
3rd, 192 1. 

Crampton, C. Ward. "Underlying Factors in Good 
Posture." New York Medical Journal, November 
27th, 1920. 



BIBLIOGRAPHY 337 

"What You Should Know About Tuberculosis." 
Pamphlet 106, Prepared by National Tuberculosis 
Association, New York. 

Halsey, Robert H. "Heart Disease in Children of 
School Age." Journal of the American Medical 
Association, Vol. Jj, No. 9, p. 672, August 27th, 192 1. 

Zingher, Abraham. "Active Immunization of In- 
fants Against Diphtheria.' ' American Journal Dis- 
eases of Children, 19 19, XVI, 83. 

Park, William H., & Zingher, Abraham. "Diph- 
theria Immunity, Natural, Active and Passive. Its 
Determination by the Schick Test." American Jour- 
nal of Public Health, 19 16, VI, 43. 

Lovett, Robert Williamson. The Treatment of In- 
fantile Paralysis, P. Blakiston's Son & Co., Phila- 
delphia, 2nd ed., 1917. 

Flexner, S., Cla'rk, P. F. & Amoss, L. "Epidemi- 
ology of Poliomyelitis.' ' Journal of Experimental 
Medicine, February 191 4. 

Terman, L. M. Hygiene of the School Child, 
Houghton, Miffin Co., Boston, 19 14. 



INDEX 



Abdomen, 124 
Adenoids, 70, 268 
Ankle, an indication of weak, 
192 
why mistake to restrict mus- 
cles at the, 190 
Apple, how to bake, 142 

sauce, 61 
Asparagus, how to cook, 160 

Baby, advantages of one bottle 
feeding daily while nurs- 
ing the, 43, 44 
bottle fed, persistent vomit- 
ing, 63, 64 
reduction of feeding in 

warm weather, 86 
sudden vomiting of, 63 
breast fed, if tendency to 

vomit, 86 
care of the eyes of the, 216 
contents of basket for, 17, 18 
nursing hours of, 39 
temperature of sleeping room 

for, 80 
to cleanse the eyes of the, 216 
when to put to breast, 37, 38 
Barley water, 49 
Bath, bran, 89 
dressing after, 33, 34 
how to give, 32, 33 
length of time after feeding, 

30 
preparation for, 30 
soda, 89 
starch, 89 

temperature of room for, 30 
of water for, 31 
Beef juice, 61, 155 
scraped, 155 



339 



Bites of animals, 137 

Bottle, care of, 69 
things to guard against when 

giving the, 66 
to test temperature of milk 
in the, 66 

Bowel irrigation, 322 

Bow legs, 120 

Brain, 77, 220, 301 

Brain-fag, dangers of, 300, 301, 
306 
signs and symptoms of, 305, 
306, See also Nervous 
system 

Bread, twice cooked, 156 

Breathing, 251 
how to stand when practic- 
ing deep, 251, 252 

Broths, 155 

Bruises and bumps, 134 

Burns, 135 

Carbolic solution, 112, 113 

Carrots, how to cook, 160 

Cauliflower, how to cook, 162, 

Cereal-jelly, 154 

Cereals, 138, 139 
how to cook, 154, 155 
necessity for long cooking) 

of, 140 
when may be given, 61 

Chicken-pox, 104 

Clothing, during pregnancy, 12, 

r I3 

for the infant (see also lay- 
ette), 24, 25, 26, 27, 28, 
29, 87, 88 

Cocoa 157 

Cold applications, 319 

Cold compresses, 319 



34° 



INDEX 



Colds, chilled carriage-robes as 
a cause of, 165 
overheating as a cause of, 

135 
Colic, 135 . 

Confinement, estimation of ex- 
pected date, 4 
length of time in bed after, 

13 
supplies for, 13, 14, IS, 10 

Constipation, avoidance of dur- 
ing pregnancy, 8 
avoidance of while nursing, 

40, 41 . 

chief causes of in bottle-fed, 

93 
chief causes of in breast-fed, 

°3 
chief causes of in "run 

about" children, 93 
diet of a "run about" when 

there is, 94 
importance of regularity in 

overcoming, 94, 95, 96 
in infants, predisposing and 

direct causes of, 90, 91, 

92 . . , 

massage as an aid in relief 

of, 97 
water as an aid in relief of, 

94, 95 
Convulsions, 128, 129 
Corsets, 11 
Croup, 129 

Deafness, contagious diseases 
as a cause of, 169 
decayed teeth, enlarged and 
diseased tonsils as 
cause for, 170 
prevention of acquired, 168, 
169 
Diapers, care of, 85, 88 
Diarrhea, 86, 87 
Diet, Choice of during preg- 
nancy, 6, 7 
for the schoolchild, 296, see 

also food, 
from 9th to 12th month, 145, 
146 



from 12th to 15th month, 147 
from 15th to 18th month, 148 
from 18th to 24th month, 150, 

151 
from 2nd to 4th year, 152, 

.153 
Diphtheria, a simple test to as- 
certain if susceptible to, 
274 
reasons some are immune 
from and others suscep- 
tible to, 273 
susceptibility of children to, 
272 
Douche, 11 

Ear, contagious diseases as a 
cause of infections of, 
169 
dry heat for beginning in- 
fection of, 175 
factors interfering with nor- 
mal balance in middle, 171 
foreign body in, 132 
how to cleanse, 32, 175, 176 
how to irrigate, 174, 175 
predisposing causes for infec- 
tions of, 170 
Earache, 131, 172, 173 
Ear-pulling, 115 
Eczema, 136, 137 
Egg, how to prepare, 141 

value of, in diet, 141 
Enema, how to give, 321, 322 
why should not be used pro- 
miscuously, 98 
Exercise, during pregnancy, 6 

while nursing, 39 
Exercises, 194, 195, 254 
Eyes, 116, 117, 123 
care of the baby's, 214, 215, 

216 
"cross eye," 116, 122, 211 
during infectious diseases, 

206 
earliest principles to teach 
child in care of, 207, 208 
foreign body in, 132 
how to cleanse, 216 
inflammation of, 216 



INDEX 



34i 



the formative stage of devel- 
opment, 207 

"squint eye," 116, 117, 210, 
211 
Eye-strain, 209 

reflex disturbances caused by, 
209, 210 

Fear, avoidance of suggestions 
that stimulate, 224 

chief source of, 223 

overdevelopment of the in- 
stinct of, 218, 219, 220, 
230 

sometimes starting point for 
peculiar phobia, 221 
Feeding, amount at a, 56, See 
also Infant and Baby 

artificial, rule for determin- 
ing volume for 24 hours, 

55 
examples of, according to 

weight, 55, 56, 58, 59, 60 
number and hours of, 55, 56 
rule for determining amount 

of milk required for, 56 
technique of, 67, 68 
things to guard against when 

giving, 66 
Feeding, breast, regularity of, 

39 
schedule for, 39 
signs of non-success of, 42, 

43 
signs of success of, 42 
technique of, 41 
Feet, 120, 249, 250 
abnormalities of, 189, 190 
exercises for strengthening 

muscles of, 194, 195 
how to protect, in wet 

weather, 166 
predisposing causes for weak- 
ness of muscles of, 193 
the position of strength, 

187, 188 
two essentials in hygiene of, 

186 
Fever, 63 



Fontanelle, anterior, 122 

posterior, 122 
Food, choice of, during preg- 
nancy, 6, 7 
fascinating names for fa- 
miliar, 327, 328 
first principles when begin- 
ning with solid, 137 
formulas of, 154, 155, 156 
for the schoolchild, 296 
Foreign body swallowed, 132 
Formula, convenient articles 
for use in preparing, 48, 

49 
examples of, 55, 56, 58, 59, 

60 
first step in mixing, 50, 51 
method of preparing cereal 

waters for, 49 
principles which may aid one 

to decide on, 55, 56, 57 
Fractures, 136 
Fruits, 143 

Hearing, 123 

how to test, 172 
Heart-diseases, cause of, 265 

how rheumatism may pro- 
duce, 265 

prevalence among school- 
children, 263 

two classes of, 266 
Hiccough, 133 
Hot fomentations, 317 
Hunger, indications of, 64 

Illness, acute, 63 

Immunities, 273 

Infant, artificial feeding of, 55, 
56, 57, 58, 59, 60 
bathing of, 32, 33, 34 
hours of sleep for, 76, 77, 78, 

79 
indications of hunger of, 64 
layette for, 24, 25, 26, 27, 28, 

29 
nursing hours for, 39, See 

also Baby 
persistent vomiting of, 63, 64 



342 



INDEX 



reduction of feeding of in 

warm weather, 86 
sudden vomiting of, 63 
summer clothing for, 87, 88 
temperature of sleeping room 

for, 80 
Infantile Paralysis, during an 

epidemic of, 284 
requirements for the control 

of, 286, 287 
the "abortive type" of, 282, 

283 
the convalescent period of, 

2Q2 

the multiform character of, 

282 
when most frequent, 281 
Infection, preventive measures 

against, 268 
principles of prevention of, 

in warm weather, 83, 84, 

8S 
Infectious diseases, 109, no, 

in, 112, 113 
Isolation, how may be carried 

out in home, 11, 109, no, 

287, 288, 289, 290 
when has been terminated, 

112, 291 

Lateral curvature, 303, 304 
Layette, 16, 17, 24, 25, 26, 27, 

28, 29 
Lime water, 49 

Malnutrition, dangers of, 196 
factors having a bearing on, 

197 
physical and mental signs 

of, 201 
physical causes that are a 

factor in, 199 
Maternal impressions, 1 
Maternity clothing, 12 
Measles, 101, 102 
Meat, how to cook, 142 
Medicine-cabinet, internal and 

external medicines for, 

128 



material and appliances for, 
127 

ointments, crystals and pow- 
ders for, 128 
Mental prophylaxis, 218, 219, 

223, 224 
Milk, care of, 48 
fat-percentages of bottled, 

52 
how to pasteurize, 51 
hew to test temperature of, 

66 
relation of human to cow's, 

46 
selection of, 46 
Miscarriage, 10 
Mumps, 104 
Muscles, why should not be 

restricted, 190 
Mustard-foot bath, 321 
Mustard-plaster, 320 

Nail biting, 119 
Nervousness, an important 
cause for, 229, 230 
factors that are a cause for, 

226, 227 
first treatment of, 226 
importance of muscular de- 
velopment in prevention 
of, 228 
Nervous system, effect of 

brain fag upon, 300 
Neurotic tendencies, two fac- 
tors responsible for, 225 
Nipple, after use of, 69 
bottle, technique of applying, 

67 
to make holes in, 67 
Nipples, care of, 10, 37 
cleansing of, 10, 37 
cracked or fissured, 38 
retracted, 10 
Nose, foreign body in, 132 

how to blow, 171 
Nose-bleed, 133 
Nursing-bottle, 51 
Nursing, advantages of one 
bottle feeding while, 43, 
44 



INDEX 



343 



avoidance of constipation 

while, 40, 41 
diet while, 39, 40 
exercise while, 39 
maternal, schedule for, 39 
regularity of, 39, See also 

Feeding, breast 
signs of non-success of, 42, 

43 
signs of success of, 42 
technique of, 41 

Orange juice, 61, 143 
Over feeding, 64 

"Pacifier," 114, 115, 117 
Peas, how to cook, 161 
Play, for invalids, 330, 331, 332, 

333 

how the desire serves a pur- 
pose, 234, 23s 

some requirements of the in- 
tellect promoted by, 235, 
236 

the development of the emo- 
tional side of one's nature 
through, 236, 237 
Poisons, 136 

Posture, faulty types of, 247, 
248 

how a vicious circle is es- 
tablished by wrong, 246, 
247 

how to begin to build for 
good, 249 

how to impress upon the 
child the habit of good, 
252, 253 

the effect of fatigue upon, 
303, 304 
Poultice, 317, 318 
Pregnancy, avoidance of con- 
stipation during, 8 

bathing during, 9 

care of the breasts during, 
10 

care of the skin during, 9 

care of the teeth during, 7, 
8, 21 



choice of diet during, 6, 7 

clothing during, 12, 13 

duration of, 4 

exercise during, 6 

positive signs of, 4 

probable signs of, 3 

shoes during, 11, 12 

sleep during, 6 

swelling of feet and legs 
during, 9 

toxemias of, 5 
Prickley heat, 136 
Prunes, juice, 61 

pulp, 61 

stewed, 156 

Recipes, 154, 155, 156 
Rheumatism, 265, 266, 267 

causes of, 266, 267 

diseased tonsils and teeth as 
a factor in, 268 

early symptoms of, 269 

preventive measures against, 
268, 269 
Rice-water, 49 
Routine for first year, 82 

Sandwiches, 325 
Scales, 72 
Scarlet fever, 103 
Schick test, 274, 276, 277, 278 
Schoolchild, diet for, 296 
diet-schedule for, 296 
food materials necessary for, 

294, 295 
the lunch-basket for the, 298 
why milk should not be 
omitted from diet of, 
297 
Self-control, 223, 224, 229 
Senna prunes, 8 
Shoes, 190, 191 
Skin, 119 

Sleep, hours of, 76, 77, 78, 79 
important cause for disturbed, 
80, 81 
Sleeping-room, temperature of, 

80 
Soups, milk vegetable, 155, 156 



344 



INDEX 



Speech-defects, importance of 
the vowel sounds, 241, 
242 
tongue gymnastics for, 243, 
244 
Spinach, 159, 160 
Squash, 161 

Stammering, causes for, 239 
constructive corrections of, 

240, 241 
destructive corrections of, 

239 
importance of vowel sounds 

when endeavoring to 

correct, 243, 244 
Starch poultice, 318 
Stockings, 192, 193 
String beans, 161 
Sugars, 57, 58 

Tables of "Average Weights 
and Heights," 202, 203, 
204 
Talking, 124 

Teeth, care of during preg- 
nancy, 7, 8, 21 
first food as a factor in de- 
velopment of, 117, 179, 
180 
how to cleanse, 184 
how unclean mouth affects 

the enamel of, 183 
importance of care of first, 

117, 181 

order of appearance of, 124, 

125 

thumb-sucking and use of 
"pacifier" a cause for de- 
formity of, 181 

when decay of most rapid, 

118, 182 
Thumb-sucking, 114, 115, 117 
Tooth-brush, 184, 185 
Tuberculosis, age when most 

prevalent, 259 
chief sources of infection, 257 
facts bearing on, 256 



measles and whooping-cough 
in the evolution of a pre- 
disposition for, 258 

milk as a source of infec- 
tion, 258 

positive signs of, 261 

the most vulnerable point of 
attack, 259 

Urine, amount of, 4 
examination of, 4 
method of collecting, 5 
sediment in, 3 

Uterus, 13 

Varicose veins, 9 
Vegetables, 61, 140, 141, 142 
Voice-speaking, essential qual- 
ities that make for a 
good, 310 
fundamental training for a 
pleasing, 311, 312, 313, 

314, 3:5 
physical essentials for a 

pleasing, 311 
Vomiting, 63, 64 
Vowel sounds, 241, 242 

Walking, 123 
Water, 9, 94, 95 
"Weak foot," an indication of, 
191, 192 
exercises for, 194, 195 
how abnormal deviations in 
weight bearing may re- 
sult in, 187 
Weaning, 44 

Weight, a large gain in, 65 
average, at birth, 121 
average gain in, 71 
examples of formulas ac- 
cording to, 55, 56, 58, 59, 
60 
sufficient gain in, 64, 65 
tables of average, 202, 203, 
204 
Whey, 49 

Whooping-cough, 105 
Wounds, 134 




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